NPIMap

Organization Active NPI

Upmc Western Maryland Corporation

Doing business as UPMC Western Maryland

  • Physiological Laboratory
  • Cumberland, MD
National Provider Identifier
1013051119
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
UPMC WESTERN MARYLAND CORPORATION
Doing business as
UPMC Western Maryland
Western Maryland Outpatient Diagnostic Center - Johnson Heights
Practice address
625 Kent Ave
Cumberland, MD 21502-3794
Phone
(240) 964-4205
Fax
(240) 964-8337
NPI assigned
Feb 20, 2007
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
UPMC WESTERN MARYLAND CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber R Ruble
Title
Sr. VP Cfo
Phone
(240) 964-8032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X MD Primary

Addresses

Primary practice location

625 Kent Ave
Cumberland, MD 21502-3794

Mailing address

625 Kent Ave
Cumberland, MD 21502-3794
Phone (240) 964-4205

Other identifiers 2

IdentifierTypeStateIssuer
62019102 KFA4MEOtherMDCAREFIRST RADIOLOGY
62019001 W478MEOtherMDCAREFIRST LABORATORY

Other names 2

  • UPMC Western Maryland Doing business as
  • Western Maryland Outpatient Diagnostic Center - Johnson Heights Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100217000735 MD Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7113900655 1 other NPI on this enrollment
Practice locations: Cumberland, MD

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Western Maryland Health Sys

Locations

625 Kent Ave
Cumberland, MD 21502
Phone (240) 964-8111

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1013051119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 KENT AVE",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215023794",
            "telephone_number": "240-964-4205",
            "fax_number": "240-964-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 KENT AVE",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215023794",
            "telephone_number": "240-964-4205",
            "fax_number": "240-964-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC WESTERN MARYLAND CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UPMC WESTERN MARYLAND CORPORATION",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "RUBLE",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SR. VP CFO",
        "authorized_official_telephone_number": "240-964-8032"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST RADIOLOGY",
            "identifier": "62019102   KFA4ME",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST LABORATORY",
            "identifier": "62019001   W478ME",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPMC Western Maryland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Maryland Outpatient Diagnostic Center - Johnson Heights",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Maryland Outpatient Diagnostic Center - Johnson Heights",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumberland, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.