NPIMap

Organization Active NPI

Medical Practices of Antietam LLC

Doing business as Meritus Sports Medicine

  • Sports Medicine (Internal Medicine) Physician
  • Hagerstown, MD
National Provider Identifier
1184481459
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
Legal business name
MEDICAL PRACTICES OF ANTIETAM LLC
Doing business as
Meritus Sports Medicine
Practice address
17301 Valley Mall Rd Ste 125
Hagerstown, MD 21740-6966
Phone
(301) 790-9237
NPI assigned
Mar 4, 2024
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Joshua Repac
Title
Cfo
Phone
(301) 790-9351

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0010X Primary

Addresses

Primary practice location

17301 Valley Mall Rd Ste 125
Hagerstown, MD 21740-6966

Mailing address

11116 Medical Campus Rd
Hagerstown, MD 21742-6710

Other names 1

  • Meritus Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324001019 MD Part B Supplier - Clinic/Group Practice 2567353865 Receives reassigned benefits from 283 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hagerstown, MD; Hancock, MD; Smithsburg, MD; Williamsport, MD; Cascade, MD; Frederick, MD

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2307114Meritus Sports Medicine - Valley Mall17301 Valley Mall Rd #125, Hagerstown, MD 21740Certificate of waiverJul 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Medical Pratices of Ant63 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

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

View all 20

Locations

14303 Lake Royer Dr
Cascade, MD 21719
Phone (240) 582-0694

11110 Medical Campus Rd
Ste 200
Hagerstown, MD 21742
Phone (301) 714-4300

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1184481459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17301 VALLEY MALL RD STE 125",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406966",
            "telephone_number": "301-790-9237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PRACTICES OF ANTIETAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "REPAC",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-790-9351"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meritus Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meritus Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.