NPIMap

Organization Active NPI

Excelsior Healthcare Enterprises

Doing business as Excelsior Expresscare And Primary Care

  • Internal Medicine Physician
  • Bowie, MD
National Provider Identifier
1225781305
Registry record updated Jan 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EXCELSIOR HEALTHCARE ENTERPRISES
Doing business as
Excelsior Expresscare And Primary Care
Practice address
12520 Fairwood Pkwy
Bowie, MD 20720-6343
Phone
(240) 486-1100
Fax
(301) 860-0765
NPI assigned
Jan 30, 2022
Last updated
Jan 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2022

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

Authorized official

Name
Wids Romeus, MDNPI 1063531259
Title
Principal
Phone
(240) 486-1100

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

12520 Fairwood Pkwy
Bowie, MD 20720-6343

Mailing address

13103 Old Chapel Rd
Bowie, MD 20720-4625
Phone (240) 486-1100

Other names 1

  • Excelsior Expresscare And Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221027000545 DC Part B Supplier - Clinic/Group Practice 7719354109 Receives reassigned benefits from 2 practitioners
Practice locations: Bowie, MD

National Provider Directory

National Provider Directory

Locations

12520 Fairwood Pkwy
Bowie, MD 20720
Phone (301) 262-2300

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": "1643500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643500800000",
    "number": "1225781305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13103 OLD CHAPEL RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204625",
            "telephone_number": "240-486-1100",
            "fax_number": "301-860-0765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12520 FAIRWOOD PKWY",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207206343",
            "telephone_number": "240-486-1100",
            "fax_number": "301-860-0765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR HEALTHCARE ENTERPRISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-30",
        "last_updated": "2022-01-30",
        "certification_date": "2022-01-30",
        "status": "A",
        "authorized_official_last_name": "ROMEUS",
        "authorized_official_first_name": "WIDS",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "240-486-1100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excelsior Expresscare And Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.