NPIMap

Organization Active NPI

1St America Infusion Services LLC

Doing business as Advanced InfusionCare

  • Home Infusion Therapy Pharmacy
  • Cockeysville, MD
National Provider Identifier
1215657903
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
1ST AMERICA INFUSION SERVICES LLC
Doing business as
Advanced InfusionCare
Practice address
10 Warren Rd Ste 220
Cockeysville, MD 21030-2531
Phone
(833) 607-2874
Fax
(866) 204-7069
NPI assigned
Sep 1, 2022
Last updated
Dec 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Authorized official

Name
Juderal Hall
Title
President
Phone
(800) 482-8466

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Home Infusion Therapy Pharmacy 3336H0001X Primary
Specialty Pharmacy 3336S0011X
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

10 Warren Rd Ste 220
Cockeysville, MD 21030-2531

Mailing address

623 Highland Colony Pkwy Ste 100
Ridgeland, MS 39157-6077
Phone (769) 300-0803

Other identifiers 2

IdentifierTypeStateIssuer
P08643OtherMDPK
212184101MedicaidMD

Other names 1

  • Advanced InfusionCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments
Home infusion therapy
Medicare-enrolled home infusion therapy supplier

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240627000190 MD DME Supplier - Pharmacy 9537259783 Practice locations: Cockeysville, MD
O20240815004022 MD Part B Supplier - Home Infusion Therapy Supplier 9537259783 Practice locations: Cockeysville, MD

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Locations

132 Fairmont St
Clinton, MS 39056
Phone (601) 988-1710

Practitioners & affiliated clinicians

Practitioners 3

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": "1661990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1215657903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 HIGHLAND COLONY PKWY STE 100",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576077",
            "telephone_number": "769-300-0803",
            "fax_number": "866-204-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WARREN RD STE 220",
            "city": "COCKEYSVILLE",
            "state": "MD",
            "postal_code": "210302531",
            "telephone_number": "833-607-2874",
            "fax_number": "866-204-7069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST AMERICA INFUSION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-01",
        "last_updated": "2022-12-28",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "JUDERAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-482-8466"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "P08643",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "212184101",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced InfusionCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cockeysville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; 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.