Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Intermountain Medical Group, Inc

Family Medicine Physician in Kingston, PA · enumerated 2006 · authorized official Jennifer Jackson, Senior Director Provider Enrollment.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1356397673

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Registry record

Entity type Organization (Type 2)

Legal business name Intermountain Medical Group, Inc

Practice address 610 Wyoming Ave, Kingston, PA, 18704

Phone (570) 288-5441

Fax (570) 288-5842

Enumeration date May 26, 2006

Last updated in NPPES Jan 25, 2022

Taxonomy & classification

133V00000X Registered Dietitian Dietary & Nutritional Service Providers Secondary

207Q00000X Family Medicine Physician Allopathic & Osteopathic Physicians Primary

207R00000X Internal Medicine Physician Allopathic & Osteopathic Physicians Secondary

207V00000X Obstetrics & Gynecology Physician Allopathic & Osteopathic Physicians Secondary

207X00000X Orthopaedic Surgery Physician Allopathic & Osteopathic Physicians Secondary

2084N0400X Neurology Physician Allopathic & Osteopathic Physicians Secondary

2085R0202X Diagnostic Radiology Physician Allopathic & Osteopathic Physicians Secondary

208600000X Surgery Physician Allopathic & Osteopathic Physicians Secondary

208800000X Urology Physician Allopathic & Osteopathic Physicians Secondary

208D00000X General Practice Physician Allopathic & Osteopathic Physicians Secondary

213ES0103X Foot & Ankle Surgery Podiatrist Podiatric Medicine & Surgery Service Providers Secondary

363AM0700X Medical Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Secondary

363L00000X Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary

Authorized official

Name Jennifer Jackson

Title Senior Director Provider Enrollment

Phone (877) 892-9815

Other identifiers

Identifier	Type	State	Issuer
100755627	Medicaid	PA	-
1624037	Other	PA	HIGHMARK BLUE SHIELD
510820	Other	PW	HIGHMARK BLUE SHIELD

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

What type of organization is Intermountain Medical Group, Inc?

Intermountain Medical Group, Inc is registered in NPPES as a Family Medicine Physician (its primary provider taxonomy).

What is a Type 2 NPI?

A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2022-01-25.