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
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.
Title
President
Phone
(410) 749-9290

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 identifiers 5

IdentifierTypeStateIssuer
20885OtherMAMSI-UNITED HEALTH CARE
915111700MedicaidMD
H788PEOtherMDCAREFIRST BLUE SHIELD
T699OtherCAREFIRST BS-FEDERAL
0000134502MedicaidDE

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

Locations

314 Franklin Ave
Ste 101
Berlin, MD 21811
Phone (410) 641-3954

2200 Executive Dr
Ste B
Hampton, VA 23666
Phone (757) 262-8644

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI-UNITED HEALTH CARE",
            "identifier": "20885",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "915111700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE SHIELD",
            "identifier": "H788PE",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BS-FEDERAL",
            "identifier": "T699",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000134502",
            "state": "DE"
        }
    ],
    "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.