ELLEN R SUPERDOCK CRNP
NPI 1497306336
Nurse Practitioner - Family in Lebanon, PA
About Ellen R Superdock Crnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ELLEN R SUPERDOCK CRNP (NPI 1497306336) is an individual family provider in Lebanon, Pennsylvania, licensed in Pennsylvania (SP020508) and active in the NPI registry since September 2019. She is enrolled in Medicare PECOS and maintains a secondary practice location in New Holland.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ellen R Superdock Crnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Ellen Superdock reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Lebanon, PA 17046
- Reassigned Medicare billing, Pennsylvania enrollment
- 94 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 17046 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 9
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LEBANON, PA 17046
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 Ellen Superdock's NPI number?
The NPI number for Ellen Superdock is 1497306336. It was assigned to this individual provider in the NPPES registry on September 23, 2019.
Where is Ellen Superdock located?
Ellen Superdock practices at 920 Church St, Lebanon, PA 17046. The listed phone number is (717) 272-2700.
What is Ellen Superdock's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Ellen Superdock enrolled in Medicare?
Yes. Ellen Superdock is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Ellen Superdock's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ellen Superdock reassigns Medicare benefits to Union Community Care (Lebanon, PA). The 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 Ellen Superdock's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Ellen Superdock was last updated on March 4, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Ellen R Superdock, CRNP · NPI 1497306336
Family physician in Lebanon, Pennsylvania. Individual provider, active in the CMS NPPES registry since September 23, 2019.
## Identity
- **NPI:** 1497306336 (Entity type: Individual)
- **Enumerated:** September 23, 2019
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** SP020508 (Pennsylvania)
- **Sole proprietor:** No
## Practice location
- **Address:** 920 CHURCH ST, Lebanon, PA 17046-4656
- **Phone:** (717) 272-2700
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Union Community Care (NPI 1841785607, Lebanon, PA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 4, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1497306336) · Data from the CMS NPPES public registry.