NPIMap

Organization Active NPI

Peninsula Eye Center PA

  • Ophthalmology Physician
  • Salisbury, MD
National Provider Identifier
1164546974
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PENINSULA EYE CENTER PA
Practice address
101 Milford Street
Salisbury, MD 21804
Phone
(410) 749-9290
Fax
(410) 543-9087
NPI assigned
Mar 19, 2007
Last updated
Nov 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Authorized official

Name
Dr. Gary P Luppens, M.D.NPI 1215099759
Title
President
Phone
(410) 749-9290

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X MD Primary

Addresses

Primary practice location

101 Milford Street
Salisbury, MD 21804

Mailing address

101 Milford Street
Salisbury, MD 21804
Phone (410) 749-9290

Other names 1

  • Peninsula Eye Surgeons PA Medical Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080229000221 MD Part B Supplier - Clinic/Group Practice 0244314235 Receives reassigned benefits from 6 practitioners
Practice locations: Salisbury, MD; Pocomoke City, MD; Berlin, MD
O20110616000814 DE Part B Supplier - Clinic/Group Practice 0244314235 Receives reassigned benefits from 6 practitioners
Practice locations: Georgetown, DE

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: lsportelli@peninsula.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1164546974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MILFORD STREET",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-749-9290",
            "fax_number": "410-543-9087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MILFORD STREET",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-749-9290",
            "fax_number": "410-543-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA EYE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "LUPPENS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-749-9290",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peninsula Eye Surgeons PA Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.