Center for Sports and Regenerative Orthopedics, LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

H67340 Issued in MD

Legal business name

CENTER FOR SPORTS AND REGENERATIVE ORTHOPEDICS, LLC

Practice address

601 Post Office Rd Ste 2a
Waldorf, MD 20602

Phone

(240) 754-7954

Fax

(240) 754-7958

NPI assigned

Dec 23, 2013

Last updated

Apr 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Miriam Razaq, M.D.

Title

Physician

Phone

(240) 754-7954

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pain and Wellness Center of Maryland, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Enrollment records 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8201/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• Mariam Razaq, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Waldorf, MD
  • NPI 1790925493

  DC

  Medicare reassignment Care Compare group NPD
• Anton Matveev

  • Physical Medicine & Rehabilitation Physician
  • Alexandria, VA
  • NPI 1356879092

  DC, MD

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1387756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649376000000",
    "number": "1225459936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 POST OFFICE RD STE 2A",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021912",
            "telephone_number": "240-754-7954",
            "fax_number": "240-754-7958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 POST OFFICE RD STE 2A",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "20602",
            "telephone_number": "240-754-7954",
            "fax_number": "240-754-7958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Post Office Rd Ste 2A",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206021912",
            "country_code": "US",
            "telephone_number": "240-754-7954",
            "fax_number": "240-754-7958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "225 Reinekers Ln Ste Gr4",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223142871",
            "country_code": "US",
            "telephone_number": "240-754-7954",
            "fax_number": "571-349-0204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR SPORTS AND REGENERATIVE ORTHOPEDICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-23",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A",
        "authorized_official_last_name": "RAZAQ",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "240-754-7954",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MD",
            "license": "H67340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589609600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain and Wellness Center of Maryland, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.