Jake Forman
NPI 1558721167ActiveIndividual· Surgery, Vascular Surgery· York, PA
Surgery, Vascular Surgery with Wellspan Medical Group, practicing in York, Pennsylvania. In 2024 Medicare paid $97,639 for 216 patients, and Part D covered 110 of their prescriptions, 89% of them generic. Penumbra, Inc. was the largest of 4 companies reporting payments in 2025, $265.02 in all, mostly food and beverage. Lists Gettysburg Hospital and 4 other hospitals as hospital affiliations.
Overview
| NPI | 1558721167 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Feb 25, 2016 |
| Last updated in NPPES | Sep 29, 2026 |
| Certified by provider | Sep 29, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Surgery, Vascular Surgery Primary | 2086S0129X | OS019891 | PA |
| Surgery, Vascular Surgery | 2086S0129X | FF2923515 | PA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Vascular Surgery (PA) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 216 |
|---|---|
| Services billed | 631 across 108 procedure codes |
| Paid by Medicare | $97,639 |
Part D prescriptions in 2024
| Prescriptions (claims) | 110 · 160 30-day fills |
|---|---|
| Patients | 36 |
| Total drug cost | $6,071 |
| Generic share | 89% of claims |
Education and affiliations
| Graduation year | 2016 |
|---|---|
| Medicare specialty | Vascular Surgery |
| Telehealth | Offers telehealth |
Medical group
- Wellspan Medical GroupEphrata, PA · 2,480 clinicians
Hospital affiliations
- Gettysburg HospitalGettysburg, PA
- Wellspan Chambersburg HospitalChambersburg, PA
- Wellspan Ephrata Community HospitalEphrata, PA
- Wellspan Good Samaritan HospitalLebanon, PA
- Wellspan York HospitalYork, PA
Industry payments (Open Payments)
- 2025$265.02 · 7 payments from 4 companies
- 2024$2,152 · 10 payments from 6 companies
Top paying companies in 2025
| Company | Amount | Payments |
|---|---|---|
| Penumbra, Inc. | $106.92 | 1 |
| Medtronic, Inc. | $85.62 | 3 |
| Microvention, Inc. | $36.55 | 1 |
| Shockwave Medical, Inc | $35.93 | 2 |
What the 2025 payments were for
- Food and Beverage$265.02 · 7 payments
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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