SUSQUEHANNA HEALTH MEDICAL GROUP
NPI 1417903683
Dermatology in Williamsport, PA

Active since May 26, 2006
699 RURAL AVE, SUITE 201, WILLIAMSPORT, PA 17701(570) 321-3121 Get Directions Write a Review

NPPES record last updated: October 19, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Susquehanna Health Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSQUEHANNA HEALTH MEDICAL GROUP (NPI 1417903683) is a healthcare organization registered as a dermatology in Williamsport, Pennsylvania and active in the NPI registry since May 2006. The organization lists Melissa Davis, Vp/coo, as its authorized official.

NPPES Registry Identity

NPI1417903683
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSUSQUEHANNA PHYSICIAN SERVICES
Location Address699 RURAL AVE, SUITE 201Williamsport, PA 17701-3251
Mailing Address1201 Grampian BlvdWilliamsport, PA 17701-1900
Organization SubpartNo
Authorized OfficialMelissa DavisVp/coo · (570) 320-7696
Enumeration DateMay 26, 2006
Last NPPES UpdateOctober 19, 2015
✔ NPI 1417903683 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
699 RURAL AVE, Williamsport, PA 17701

Other Names 1

Doing Business AsSusquehanna Health Medical Group

Other Identifiers 3

Medicare PINCC0890PA
Other274804PA · Blue Shield
Medicaid0017300760204PA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Susquehanna Health Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Susquehanna Health Medical Group, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1447227707
1205 GRAMPIAN BLVD STE 1A
Williamsport, PA 17701
(570) 326-8060
✔ PECOS✔ Accepts Medicare1.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susquehanna Physician Services's NPI number?

The NPI number for Susquehanna Physician Services is 1417903683. It was assigned to this organization in the NPPES registry on May 26, 2006. The provider is doing business as Susquehanna Health Medical Group.

Where is Susquehanna Physician Services located?

Susquehanna Physician Services is located at 699 Rural Ave Suite 201, Williamsport, PA 17701. The listed phone number is (570) 321-3121.

What is Susquehanna Physician Services's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Susquehanna Physician Services enrolled in Medicare?

Yes. Susquehanna Physician Services is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Susquehanna Physician Services?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Susquehanna Physician Services. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Susquehanna Physician Services was last updated on October 19, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.