NPIMap

Organization Active NPI

Luminis Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Easton, MD
National Provider Identifier
1164088795
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
LUMINIS HEALTH MEDICAL GROUP, LLC
Practice address
28438 Marlboro Ave
Easton, MD 21601-2732
Phone
(410) 822-2440
NPI assigned
May 20, 2019
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Peter Odenwald
Title
Vice President
Phone
(443) 481-6415

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050317000146 MD Part B Supplier - Clinic/Group Practice 2860447315 Receives reassigned benefits from 897 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Anne Arundel Phys Group LLC221 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

28438 Marlboro Ave
Easton, MD 21601-2732

Mailing address

PO Box 12622
Belfast, ME 04915-4017

Other names 1

NPPES NPI Registry
  • AAMC's Women's Center for Pelvic Health Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 24, 2021.

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1164088795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12622",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28438 MARLBORO AVE",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216012732",
            "telephone_number": "410-822-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINIS HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-20",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "ODENWALD",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "443-481-6415"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AAMC's Women's Center for Pelvic Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AAMC's Women's Center for Pelvic Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.