NPIMap

Organization Active NPI

St. Mary's Multispecialty Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Great Mills, MD
National Provider Identifier
1245249754
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1147 Issued in MD
Legal business name
ST. MARY'S MULTISPECIALTY SURGERY CENTER
Practice address
22325 Greenview Pkwy
Great Mills, MD 20634-3491
Phone
(301) 862-3338
Fax
(301) 862-3335
NPI assigned
Aug 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Douglas H Hallgren, D.P.M.NPI 1336158955
Title
President
Phone
(301) 862-3338

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A1147 MD Primary

Addresses

Primary practice location

22325 Greenview Pkwy
Great Mills, MD 20634-3491

Mailing address

PO Box 1310
California, MD 20619-1310
Phone (301) 862-3338

Other identifiers 2

IdentifierTypeStateIssuer
NK9OtherMDBLUE CROSS BLUE SHIELD
58380901OtherMDBLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245249754. Details of each certification follow.

Ambulatory surgical center certification: CCN 21C0001147

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ST MARY'S MULTISPECIALTY SURGERY CENTRE, PA
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Dec 9, 1994
Last certification
Aug 16, 2019
Ownership / control type
Proprietary
Facility address
22325 Greenview Parkway, West
Great Mills, MD 20634

National Provider Directory

National Provider Directory
Tax ID family
St Mary's Multi-Specialty Surgery Centre Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245249754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1310",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206191310",
            "telephone_number": "301-862-3338",
            "fax_number": "301-862-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22325 GREENVIEW PKWY",
            "city": "GREAT MILLS",
            "state": "MD",
            "postal_code": "206343491",
            "telephone_number": "301-862-3338",
            "fax_number": "301-862-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MULTISPECIALTY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALLGREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-862-3338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NK9",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "58380901",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Mills, MD

Sources for this page

Verify at the official NPI Registry.