Advantia Surgical LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ADVANTIA SURGICAL LLC

Doing business as

Advantia Health Indian Creek ASC

Practice address

12240 Indian Creek CT Ste 130
Beltsville, MD 20705-1260

Phone

(240) 560-5092

NPI assigned

Feb 3, 2015

Last updated

Jun 28, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

ADVANTIA HOLDINGS OF MARYLAND LLCAs reported in NPPES

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

Authorized official

Name

Dr. Peter Glass, MB. CHB. FFA (SA)

Title

Chief Medical Officer

Phone

(240) 560-5092

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Advantia Health Indian Creek ASC Doing business as

Part of

Advantia Holdings of Maryland LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Maryland Physicians Edge LLC

  • Obstetrics & Gynecology Physician
  • Silver Spring, MD
  • NPI 1972922920

  Member Of

  NPD member

Locations

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.

• Advantia Holdings of Maryland LLC

  • Obstetrics & Gynecology Physician
  • Silver Spring, MD
  • NPI 1861932170
  NPPES parent name

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498608000000",
    "number": "1245620871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12240 INDIAN CREEK CT STE 130",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207051260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12240 INDIAN CREEK CT STE 130",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207051260",
            "telephone_number": "240-560-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTIA SURGICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANTIA HOLDINGS OF MARYLAND LLC",
        "enumeration_date": "2015-02-03",
        "last_updated": "2017-06-28",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "240-560-5092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MB. CHB. FFA (SA)"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE JOINT COMMISSION CERTIFICATION",
            "identifier": "582166",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD STATE ASC LICENSE",
            "identifier": "A1572",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advantia Health Indian Creek ASC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Beltsville, MD
• Providers in Beltsville, MD by specialty
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.