NPIMap

Organization Active NPI

Maryland Imaging Network PC

  • Diagnostic Radiology Physician
  • Waldorf, MD
National Provider Identifier
1235970799
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MARYLAND IMAGING NETWORK PC
Practice address
11335 Pembrooke Square
Stes 101, 104, 113, 114, & 116
Waldorf, MD 20603-4845
Phone
(410) 298-0454
Fax
(443) 436-1214
NPI assigned
Jun 6, 2024
Organization subpart
Yes
Parent organization
MARYLAND IMAGING NETWORK PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Authorized official

Name
John Vernon Crues
Title
Owner
Phone
(310) 445-2843

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207U00000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

11335 Pembrooke Square
Stes 101, 104, 113, 114, & 116
Waldorf, MD 20603-4845

Mailing address

10461 Mill Run Cir Ste 1020
Owings Mills, MD 21117-5544
Phone (443) 436-1221

Other names 1

  • MIN - Pembrooke Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191202001049 MD Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 71 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Glen Burnie, MD; Highland, MD; Laurel, MD; Lutherville Timonium, MD; New Market, MD; North Beach, MD; Prince Frederick, MD…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Maryland Imaging Network PC8 organizations share this tax ID, including this one
Part of
Maryland Imaging Network PC

Other organizations with this tax ID 7

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

Locations

130 Hospital Rd
Ste LL100
Prnc Frederck, MD 20678
Phone (410) 535-4111

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1235970799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 MILL RUN CIR STE 1020",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175544",
            "telephone_number": "443-436-1221",
            "fax_number": "443-436-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11335 PEMBROOKE SQUARE",
            "address_2": "STES 101, 104, 113, 114, & 116",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034845",
            "telephone_number": "410-298-0454",
            "fax_number": "443-436-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND IMAGING NETWORK PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYLAND IMAGING NETWORK PC",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A",
        "authorized_official_last_name": "CRUES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-445-2843"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIN - Pembrooke",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; 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.