NPIMap

Individual provider Active NPI

Logan Harrison Robertson

  • Medical Physician Assistant
  • Hagerstown, MD
National Provider Identifier
1093343402
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C0008038 Issued in MD
Practice address
11110 Medical Campus Rd Ste 200
Hagerstown, MD 21742-6797
Phone
(301) 714-4400
NPI assigned
Mar 31, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C08038 MD
Student in an Organized Health Care Education/Training Program 390200000X
Medical Physician Assistant 363AM0700X C0008038 MD Primary

Addresses

Primary practice location

11110 Medical Campus Rd Ste 200
Hagerstown, MD 21742-6797

Mailing address

11110 Medical Campus Rd Ste 200
Hagerstown, MD 21742-6797
Phone (301) 714-4400

Other practice location 1

1583 Luther Michael Rd
Berkeley Springs, WV 25411-7263
Phone (304) 839-4215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210820001657 MD Practitioner - Physician Assistant 1153726617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700
Phone (301) 790-9496

3 Byrkit Dr
Williamsport, MD 21795-1158
Phone (301) 582-1150

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0008038MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Practices of Antietam LLC CurrentSince Aug 2, 2021 Accepting new patients
Medical Practices of Antietam LLC CurrentSince Aug 2, 2021 Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

11110 Medical Campus Rd
Ste 200
Hagerstown, MD 21742
Phone (301) 714-4300

13620 Crayton Blvd
Hagerstown, MD 21742
Phone (240) 313-3100

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

11116 Medical Campus Rd
Ste 200
Hagerstown, MD 21742
Phone (301) 790-9244

17301 Valley Mall Rd
Ste 125
Hagerstown, MD 21740
Phone (301) 790-9236

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1093343402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426797",
            "telephone_number": "301-714-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426797",
            "telephone_number": "301-714-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1583 Luther Michael Rd",
            "address_purpose": "LOCATION",
            "city": "Berkeley Springs",
            "state": "WV",
            "postal_code": "254117263",
            "country_code": "US",
            "telephone_number": "304-839-4215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "LOGAN",
        "middle_name": "HARRISON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C08038",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0008038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.