NPIMap

Organization Active NPI

Wolf Medical Group, LLC

  • Family Medicine Physician
  • Rising Sun, MD
National Provider Identifier
1205440153
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WOLF MEDICAL GROUP, LLC
Practice address
101 Colonial Way Ste B
Rising Sun, MD 21911-2272
Phone
(443) 485-9116
Fax
(877) 426-3121
NPI assigned
Sep 8, 2020
Last updated
Feb 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Authorized official

Name
Dr. Robert Jordan Wolf, MDNPI 1215925235
Title
Owner
Phone
(443) 485-9116

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

101 Colonial Way Ste B
Rising Sun, MD 21911-2272

Mailing address

120 Ryan Dr
Rising Sun, MD 21911-1840
Phone (443) 485-9116

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200928002761 MD Part B Supplier - Clinic/Group Practice 7719306505 Receives reassigned benefits from 2 practitioners
Practice locations: Rising Sun, MD

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
21D2213793Wolf Medical Group101 Colonial Way Suite B, Rising Sun, MD 21911Certificate of waiverFeb 16, 2027

National Provider Directory

National Provider Directory

Locations

361 Fair Hill Dr
Elkton, MD 21921
Phone (410) 620-7260

101 Colonial Way
Ste B
Rising Sun, MD 21911
Phone (410) 658-0963

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1205440153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RYAN DR",
            "city": "RISING SUN",
            "state": "MD",
            "postal_code": "219111840",
            "telephone_number": "443-485-9116",
            "fax_number": "877-426-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 COLONIAL WAY STE B",
            "city": "RISING SUN",
            "state": "MD",
            "postal_code": "219112272",
            "telephone_number": "443-485-9116",
            "fax_number": "877-426-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLF MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-485-9116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rising Sun, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; 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.