NPIMap

Organization Active NPI

Mdics at Civista LLC

  • Hospitalist Physician
  • La Plata, MD
National Provider Identifier
1225323496
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
MDICS AT CIVISTA LLC
Practice address
5 Garrett Ave
La Plata, MD 20646-5960
Phone
(443) 949-0814
Fax
(443) 949-0825
NPI assigned
Jun 15, 2011
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
Tim Delbrugge
Title
Cfo
Phone
(301) 693-8707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD Primary

Addresses

Primary practice location

5 Garrett Ave
La Plata, MD 20646-5960

Mailing address

PO Box 69231
Baltimore, MD 21264-9231
Phone (443) 949-0814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120206000334 MD Part B Supplier - Clinic/Group Practice 4981861903 Receives reassigned benefits from 71 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pikesville, MD; Glen Burnie, MD; Hagerstown, MD; La Plata, MD; Leonardtown, MD; Lexington Park, MD; Prince Frederick, MD; Randallstown, MD…
O20120501000281 MD Part B Supplier - Clinic/Group Practice 8325200793 Receives reassigned benefits from 61 practitioners
Practice locations: La Plata, MD

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Mdics Rehabilitative Services LLC46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

Locations

123 Morris Dr
La Plata, MD 20646

13325 Dowell Rd
Solomons, MD 20688
Phone (301) 772-0484

Practitioners & affiliated clinicians

Practitioners 107

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 107

NPI Registry JSON

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1225323496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69231",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212649231",
            "telephone_number": "443-949-0814",
            "fax_number": "443-292-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960",
            "telephone_number": "443-949-0814",
            "fax_number": "443-949-0825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDICS AT CIVISTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "DELBRUGGE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-693-8707"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.