Pax River Medical Clinic, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

H0055958 Issued in MD

Legal business name

PAX RIVER MEDICAL CLINIC, LLC

Practice address

46940 S Shangri la Dr
Suite #19
Lexington Park, MD 20653-1037

Phone

(301) 863-8101

Fax

(301) 863-8130

NPI assigned

Aug 22, 2007

Last updated

May 9, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Katherine Ann Martin, DONPI 1437267986

Title

Owner

Phone

(301) 863-8101

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 3

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.

• Katherine A Martin, DO

  • Family Medicine Physician
  • Lexington Park, MD
  • NPI 1437267986
  Medicare reassignment NPD Authorized official
• Jessica I Egwuagu, FNP-C

  • Family Nurse Practitioner
  • Cedar Park, TX
  • NPI 1922635366
  NPD (past)
• Daniel W. Robinson, BS DC

  • Chiropractor
  • Northridge, CA
  • NPI 1316096282
  NPD (past)

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399593600000",
    "number": "1083807085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46940 S SHANGRI LA DR",
            "address_2": "SUITE #19",
            "city": "LEXINGTON PARK",
            "state": "MD",
            "postal_code": "206531037",
            "telephone_number": "301-863-8101",
            "fax_number": "301-863-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46940 S SHANGRI LA DR",
            "address_2": "SUITE #19",
            "city": "LEXINGTON PARK",
            "state": "MD",
            "postal_code": "206531037",
            "telephone_number": "301-863-8101",
            "fax_number": "301-863-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAX RIVER MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2014-05-09",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-863-8101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MD",
            "license": "H0055958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011218600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1437267986",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antonia Sonte Parham
• Valerie Rose Pasch, FNP
• Pastoral Counseling Center of St. Mary's, Inc.
• Pathways Inc
• Pax River Counseling, LLC
• Sarah Perry, CRNP
• Personalized Academy of Learning Inc (Pals)
• Kaitlin Pignatiello, LCSW-C
• Kristen Piniewski, RDH
• Randi Pinno, AU.D.

• General Practice Physician in Lexington Park, MD
• Providers in Lexington Park, MD by specialty
• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; 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.