NPIMap

Organization Active NPI

Vivis Family Medicine LLC

  • Primary Care Clinic/Center
  • Upper Marlboro, MD
National Provider Identifier
1174237200
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
VIVIS FAMILY MEDICINE LLC
Practice address
3606 Chancelsors Dr
Upper Marlboro, MD 20772-8194
Phone
(240) 687-4317
Fax
(218) 264-3428
NPI assigned
Jan 12, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Authorized official

Name
Hedwig Manga WilliamsNPI 1487098521
Title
Provider
Phone
(240) 605-5215

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

3606 Chancelsors Dr
Upper Marlboro, MD 20772-8194

Mailing address

3606 Chancelsors Dr
Upper Marlboro, MD 20772-8194
Phone (240) 687-4317

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230215002459 DC Part B Supplier - Clinic/Group Practice 5092187211 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Upper Marlboro, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Vivis Family Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1174237200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 CHANCELSORS DR",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207728194",
            "telephone_number": "240-687-4317",
            "fax_number": "218-264-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 CHANCELSORS DR",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207728194",
            "telephone_number": "240-687-4317",
            "fax_number": "218-264-3428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVIS FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "MANGA WILLIAMS",
        "authorized_official_first_name": "HEDWIG",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "240-605-5215"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.