NPIMap

Organization Active NPI

Maryland Real Life Designs, LLC

  • Prosthetic/Orthotic Supplier
  • Abingdon, MD
National Provider Identifier
1124028535
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
12027054 Issued in MD
Legal business name
MARYLAND REAL LIFE DESIGNS, LLC
Practice address
3435 Box Hill Corporate Center Dr
Suite D
Abingdon, MD 21009-1204
Phone
(410) 569-0606
Fax
(410) 569-7477
NPI assigned
Jul 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Prof. Jonas W Seeberg, CPO
Title
Member/ President
Phone
(410) 569-0606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X 12027054 MD Primary

Addresses

Primary practice location

3435 Box Hill Corporate Center Dr
Suite D
Abingdon, MD 21009-1204

Mailing address

3435 Box Hill Corporate Center Dr
Suite D
Abingdon, MD 21009-1204
Phone (410) 569-0606

Other identifiers 1

IdentifierTypeStateIssuer
011103100MedicaidMD

Other names 1

  • Real Life Prosthetics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930028700 MD DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 1355453259 Practice locations: Abingdon, MD

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Real Life Prosthetics3435 Box Hill Corporate Center Dr, Abingdon, MD 21009-1204(410) 569-0606 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since May 3, 2001

National Provider Directory

National Provider Directory
Tax ID family
Maryland Real Life Designs LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1124028535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 BOX HILL CORPORATE CENTER DR",
            "address_2": "SUITE D",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "210091204",
            "telephone_number": "410-569-0606",
            "fax_number": "410-569-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 BOX HILL CORPORATE CENTER DR",
            "address_2": "SUITE D",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "210091204",
            "telephone_number": "410-569-0606",
            "fax_number": "410-569-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND REAL LIFE DESIGNS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "SEEBERG",
        "authorized_official_first_name": "JONAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEMBER/ PRESIDENT",
        "authorized_official_telephone_number": "410-569-0606",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MD",
            "license": "12027054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011103100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Real Life Prosthetics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Abingdon, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.