Organization Active NPI

Gastroenterology Associates, Pear M. Enam, M.D., PA

  • Specialist
  • Hagerstown, MD
National Provider Identifier
1104934942
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA
Practice address
11110 Medical Campus Rd
Suite 250
Hagerstown, MD 21742-6700
Phone
(301) 733-4404
Fax
(301) 733-3984
NPI assigned
Aug 29, 2006
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Stacey Blizzard
Title
Office Manager
Phone
(301) 733-4404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 250
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Rd
Suite 250
Hagerstown, MD 21742-6700
Phone (301) 733-4404

Other identifiers 16

IdentifierTypeStateIssuer
533100OtherAETNA - ENAM
1538148283OtherINDIVIDUAL NPI - CHOUDARI
4400511OtherAETNA - PPO - ENAM
265001100MedicaidMD
614460-02OtherCAREFIRST - HANIF
2123375OtherALLIANCE - ENAM
526933-02OtherCAREFIRST - ENAM
1780687616OtherNPI INDIVIDUAL - ENAM
2123380OtherALLIANCE - HANIF
5531514OtherAETNA - PPO - GROUP
1285637116OtherNPI INDIVIDUAL - HANIF
5476652OtherAETNA - PPO - HANIF
2003711OtherAETNA - HMO - GOUP
2010644OtherAETNA - HANIF
515001900MedicaidMD
606031500MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050324000962 MD Part B Supplier - Clinic/Group Practice 5092761833 Receives reassigned benefits from 7 practitioners
Practice locations: Hagerstown, MD

National Provider Directory

National Provider Directory

Locations

11110 Medical Campus Rd
Ste 250
Hagerstown, MD 21742
Phone (301) 665-4960

1933 Market Square Blvd
Waynesboro, PA 17268
Phone (717) 655-7536

Practitioners & affiliated clinicians

Practitioners 8

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": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1104934942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 250",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-733-4404",
            "fax_number": "301-733-3984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 250",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-733-4404",
            "fax_number": "301-733-3984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "BLIZZARD",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-733-4404"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - ENAM",
            "identifier": "533100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI - CHOUDARI",
            "identifier": "1538148283",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - PPO - ENAM",
            "identifier": "4400511",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265001100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST - HANIF",
            "identifier": "614460-02",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE - ENAM",
            "identifier": "2123375",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST - ENAM",
            "identifier": "526933-02",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL - ENAM",
            "identifier": "1780687616",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE - HANIF",
            "identifier": "2123380",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - PPO - GROUP",
            "identifier": "5531514",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL - HANIF",
            "identifier": "1285637116",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - PPO - HANIF",
            "identifier": "5476652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - HMO - GOUP",
            "identifier": "2003711",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - HANIF",
            "identifier": "2010644",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "515001900",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606031500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.