Individual provider Active NPI

Mary Rose Anne Manibog, MD

  • Family Medicine Physician
  • Greenbelt, MD
National Provider Identifier
1255892725
Registry record updated Sep 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0094630 Issued in MD
Practice address
7500 Greenway Center Dr Ste 1200
Greenbelt, MD 20770-3556
Phone
(301) 486-7680
NPI assigned
Mar 27, 2019
Last updated
Sep 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D0094630 MD Primary

Addresses

Primary practice location

7500 Greenway Center Dr Ste 1200
Greenbelt, MD 20770-3556

Mailing address

7500 Greenway Center Dr Ste 1200
Greenbelt, MD 20770-3556
Phone (301) 486-7580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220815000370 DC Practitioner - Family Practice 3678956232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern Maryland Medical Group LLCGroup PAC ID 5395893655, 21 clinicians

Practice addresses (Care Compare)

6410 Rockledge Dr
Suite 600
Bethesda, MD 20817-1844

7500 Greenway Ctr Dr
Suite 1200
Greenbelt, MD 20770-3556
Phone (301) 486-7580

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87 of 100Reported as group
Quality
86.7
Promoting interoperability
99
Improvement activities
40
Cost
70.8

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0094630MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Maryland Medical Group LLC Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5801 Allentown Rd
Ste 400
Camp Springs, MD 20746
Phone (301) 868-0150

7500 Greenway Center Dr
Ste 1200
Greenbelt, MD 20770
Phone (301) 486-7580

8116 Good Luck Rd
Ste 305
Lanham, MD 20706
Phone (301) 486-7580

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662163200000",
    "number": "1255892725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 GREENWAY CENTER DR STE 1200",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703556",
            "telephone_number": "301-486-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 GREENWAY CENTER DR STE 1200",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703556",
            "telephone_number": "301-486-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIBOG",
        "first_name": "MARY ROSE ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2022-09-03",
        "certification_date": "2022-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0094630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbelt, MD

Sources for this page

Verify at the official NPI Registry.