NPIMap

Organization Active NPI

Cruz-Lee-Llacer & Associates P a

  • Critical Care Medicine (Internal Medicine) Physician
  • Clinton, MD
National Provider Identifier
1033247390
Registry record updated Sep 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
D0050412 Issued in MD
Legal business name
CRUZ-LEE-LLACER & ASSOCIATES P A
Practice address
8909 Old Branch Ave
Clinton, MD 20735-2528
Phone
(301) 868-7780
Fax
(202) 403-0508
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2014

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

Authorized official

Name
Dr. Natesa Shanmugam
Title
Treasurer
Phone
(301) 868-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X D0050412 MD Primary

Addresses

Primary practice location

8909 Old Branch Ave
Clinton, MD 20735-2528

Mailing address

8909 Old Branch Ave
Clinton, MD 20735-2528
Phone (301) 868-7780

Other identifiers 3

IdentifierTypeStateIssuer
C10291OtherMDUNITEDHEALTHCARERAILROAD
289091700MedicaidMD
6875OtherDCCAREFIRST BLUE CROSS

National Provider Directory

National Provider Directory

Locations

9134 Piscataway Rd
Unit 297
Clinton, MD 20735

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410220800000",
    "number": "1033247390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8909 OLD BRANCH AVE",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352528",
            "telephone_number": "301-868-7780",
            "fax_number": "202-403-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8909 OLD BRANCH AVE",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352528",
            "telephone_number": "301-868-7780",
            "fax_number": "202-403-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRUZ-LEE-LLACER & ASSOCIATES P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2014-09-09",
        "status": "A",
        "authorized_official_last_name": "SHANMUGAM",
        "authorized_official_first_name": "NATESA",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "301-868-7780",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MD",
            "license": "D0050412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARERAILROAD",
            "identifier": "C10291",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289091700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS",
            "identifier": "6875",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.