NPIMap

Organization Active NPI

White Square Vascular Surgery PA

  • Vascular Surgery Physician
  • Baltimore, MD
National Provider Identifier
1285666008
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
WHITE SQUARE VASCULAR SURGERY PA
Practice address
5233 King Ave
Suite 208
Baltimore, MD 21237-4003
Phone
(410) 918-1525
Fax
(410) 918-1526
NPI assigned
Jul 6, 2006
Last updated
Jan 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Authorized official

Name
Ahmad Abu-Ghaida, M.D.NPI 1659320257
Title
President
Phone
(410) 918-1525

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

5233 King Ave
Suite 208
Baltimore, MD 21237-4003

Mailing address

10845 Philadelphia Rd
White Marsh, MD 21162-1717
Phone (410) 335-0008

Other identifiers 4

IdentifierTypeStateIssuer
462105100OtherMDMEDICAL ASSISTANCE
09QSAMOtherMDCAREFIRST MD
DF0610OtherGARAILROAD MEDICARE
4490OtherDCCAREFIRST DC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061016000579 MD Part B Supplier - Clinic/Group Practice 5890791735 Receives reassigned benefits from 9 practitioners
Practice locations: Baltimore, MD; Nottingham, MD; Lutherville, MD; Bel Air, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1285666008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10845 PHILADELPHIA RD",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "211621717",
            "telephone_number": "410-335-0008",
            "fax_number": "410-335-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5233 KING AVE",
            "address_2": "SUITE 208",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212374003",
            "telephone_number": "410-918-1525",
            "fax_number": "410-918-1526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE SQUARE VASCULAR SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "ABU-GHAIDA",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-918-1525",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "462105100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD",
            "identifier": "09QSAM",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF0610",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST DC",
            "identifier": "4490",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.