NPIMap

Organization Active NPI

316TH Medgrp-Malcolm Grow

  • Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
  • JB Andrews, MD
National Provider Identifier
1215994660
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military and U.S. Coast Guard Ambulatory Procedure Clinic/CenterTaxonomy code 261QM1101X
Legal business name
316TH MEDGRP-MALCOLM GROW
Practice address
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Phone
(240) 857-8658
Fax
(240) 857-7700
NPI assigned
Apr 28, 2006
Organization subpart
Yes
Parent organization
316TH MEDGRP-MALCOLM GROWAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Authorized official

Name
William Michael Condon
Title
Dha Financial Manager
Phone
(240) 401-3643

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center 261QM1101X Primary

Addresses

Primary practice location

1060 W Perimeter Rd
JB Andrews, MD 20762-6602

Mailing address

1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Phone (240) 857-8658

Other names 1

  • 779th Medical Group Other name

National Provider Directory

National Provider Directory
Tax ID family
316TH Medgrp-Malcolm Grow2 organizations share this tax ID, including this one
Part of
316TH Medgrp-Malcolm Grow

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741737600000",
    "number": "1215994660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 W PERIMETER RD",
            "city": "JB ANDREWS",
            "state": "MD",
            "postal_code": "207626602",
            "telephone_number": "240-857-8658",
            "fax_number": "240-857-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 W PERIMETER RD",
            "city": "JB ANDREWS",
            "state": "MD",
            "postal_code": "207626602",
            "telephone_number": "240-857-8658",
            "fax_number": "240-857-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "316TH MEDGRP-MALCOLM GROW",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "316TH MEDGRP-MALCOLM GROW",
        "enumeration_date": "2006-04-28",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DHA FINANCIAL MANAGER",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "779th Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "779th Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in JB Andrews, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.