NPIMap

Organization Active NPI

Upmc Western Maryland Corporation

Doing business as UPMC Western Maryland

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cumberland, MD
National Provider Identifier
1174667802
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
CERTIFICATION #44 Issued in MD
Legal business name
UPMC WESTERN MARYLAND CORPORATION
Doing business as
UPMC Western Maryland
Practice address
12502 Willowbrook Rd
Suite 250
Cumberland, MD 21502-6491
Phone
(240) 964-8342
Fax
(240) 964-8337
NPI assigned
Feb 16, 2007
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
UPMC WESTERN MARYLAND CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Amber Renee Ruble
Title
Sr. VP Cfo
Phone
(240) 964-8032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X CERTIFICATION #44 MD Primary

Addresses

Primary practice location

12502 Willowbrook Rd
Suite 250
Cumberland, MD 21502-6491

Mailing address

12502 Willowbrook Rd
Suite 250
Cumberland, MD 21502-6491
Phone (240) 964-8342

Other identifiers 3

IdentifierTypeStateIssuer
759251500MedicaidMD
59010001OtherMDCAREFIRST BC BS
MB4OtherDCBLUE CHOICE

Other names 1

  • UPMC Western Maryland Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091125000486 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 7113900655 Practice locations: Cumberland, MD

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Western Maryland Regional Dialysis CenterCCN 212302
Overall star rating
1.0 of 5
Ownership
Non-profit
Certified
Aug 24, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
35

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hospital9 organizations share this tax ID, including this one
Part of
Psychaitric Physician S

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1174667802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12502 WILLOWBROOK RD",
            "address_2": "SUITE 250",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215026491",
            "telephone_number": "240-964-8342",
            "fax_number": "240-964-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12502 WILLOWBROOK RD",
            "address_2": "SUITE 250",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215026491",
            "telephone_number": "240-964-8342",
            "fax_number": "240-964-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC WESTERN MARYLAND CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UPMC WESTERN MARYLAND CORPORATION",
        "enumeration_date": "2007-02-16",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "RUBLE",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "SR. VP CFO",
        "authorized_official_telephone_number": "240-964-8032"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "CERTIFICATION #44",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "759251500",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC BS",
            "identifier": "59010001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "MB4",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPMC Western Maryland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumberland, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.