NPIMap

Organization Active NPI

Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Capitol Heights, MD
National Provider Identifier
1093987729
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER BADEN MEDICAL SERVICE INCORPORATED
Practice address
1442 Addison Rd S
Capitol Heights, MD 20743-4413
Phone
(301) 324-1500
Fax
(240) 492-2526
NPI assigned
Apr 2, 2008
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GREATER BADEN MEDICAL SERVICE INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Jeffrey A Kurcab
Title
Cfo
Phone
(301) 599-2172

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Health Educator 174H00000X NU

Addresses

Primary practice location

1442 Addison Rd S
Capitol Heights, MD 20743-4413

Mailing address

7450 Albert Rd FL 3
Brandywine, MD 20613-3035
Phone (301) 888-2233

Other identifiers 1

IdentifierTypeStateIssuer
911431900MedicaidMD

Other names 1

  • Greater Baden Medical Service at Capitol Heights II Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080222000437 MD Part A Provider - Federally Qualified Health Center (FQHC) 4981632650 1 other NPI on this enrollment
Practice locations: Capitol Heights, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093987729. Details of each certification follow.

Federally qualified health center certification: CCN 211867

Legal name
GREATER BADEN MEDICAL SERVICE INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 22, 2008
Last certification
Feb 22, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 6, 1972 in MD
Enrollment address
1442 Addison Rd S
Capitol Heights, MD 20743-4413

Other NPIs with the same Medicare PAC ID 9

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
Tax ID family
Greater Baden Med SVC Inc15 organizations share this tax ID, including this one
Part of
Greater Baden Med SVC Inc

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Roxann Cooper Individual Corporate DirectorBoard Member May 1, 2021
Joan F Hepburn Individual Corporate DirectorBoard Member Jan 1, 2023
Dale E Speake Individual Corporate DirectorBoard Member Jan 1, 2023
Jeffrey a Kurcab Individual Corporate OfficerCfo Jan 1, 2023 100%
W-2 Managing EmployeeCfo Jan 1, 2023 100%
Brandon Jones Individual Corporate DirectorChair Jan 1, 2023
Christopher Demarco Individual Corporate OfficerCeo Jan 1, 2023 100%
Ruth Jackson Individual Corporate DirectorBoard Member Jan 1, 2023
Robert Harold Eaton Individual Corporate DirectorTreasurer Jan 1, 2023
Mary Ann Friis Individual Corporate DirectorVice Chair Oct 1, 2020

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1093987729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 ALBERT RD FL 3",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133035",
            "telephone_number": "301-888-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1442 ADDISON RD S",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207434413",
            "telephone_number": "301-324-1500",
            "fax_number": "240-492-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER BADEN MEDICAL SERVICE INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER BADEN MEDICAL SERVICE INCORPORATED",
        "enumeration_date": "2008-04-02",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "KURCAB",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-599-2172"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911431900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Baden Medical Service at Capitol Heights II",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Capitol Heights, MD

Sources for this page

Verify at the official NPI Registry.