NPIMap

Organization Active NPI

Maryland Brain Spine & Pain LLC

  • Neurological Surgery Physician
  • Bowie, MD
National Provider Identifier
1043288376
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
MARYLAND BRAIN SPINE & PAIN LLC
Practice address
4201 Northview Dr Ste 101
Bowie, MD 20716-2644
Phone
(410) 266-2720
Fax
(410) 224-0209
NPI assigned
Mar 11, 2006
Last updated
Nov 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

Name
Dr. Brian J Sullivan, M.D.NPI 1013915883
Title
President/Physician
Phone
(410) 266-2720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

4201 Northview Dr Ste 101
Bowie, MD 20716-2644

Mailing address

1000 Bestgate Rd Ste 400
Annapolis, MD 21401-3371
Phone (410) 266-2720

Other identifiers 4

IdentifierTypeStateIssuer
D380OtherDCBCBS
404557200MedicaidMD
404557201MedicaidMD
003QMAOtherMDBCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1142035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1043288376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BESTGATE RD STE 400",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013371",
            "telephone_number": "410-266-2720",
            "fax_number": "443-224-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 NORTHVIEW DR STE 101",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207162644",
            "telephone_number": "410-266-2720",
            "fax_number": "410-224-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND BRAIN SPINE & PAIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-11",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "410-266-2720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "D380",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404557200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404557201",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "003QMA",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; 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.