NPIMap

Organization Active NPI

Newbridge Surgery Center at Prince Frederick, LLC

  • Ambulatory Surgical Clinic/Center
  • Prince Frederick, MD
National Provider Identifier
1285944504
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC
Practice address
80 Sherry LN Ste 101B
Prince Frederick, MD 20678-3232
Phone
(410) 414-9229
Fax
(410) 414-9339
NPI assigned
Oct 20, 2010
Last updated
Apr 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Mruthyunjaya Gonchigar, M.D.NPI 1043275449
Title
Sole Owner
Phone
(301) 461-6687

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
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

80 Sherry LN Ste 101B
Prince Frederick, MD 20678-3232

Mailing address

196 Thomas Johnson Dr
Suite 215
Frederick, MD 21702-4397
Phone (301) 668-9988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110322000585 MD Part B Supplier - Ambulatory Surgical Center 0244413607 Practice locations: Prince Frederick, MD
O20230412002140 MD Part B Supplier - Clinic/Group Practice 9133416191 Receives reassigned benefits from 1 practitioner
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfax, VA; Frederick, MD; Potomac, MD; Prince Frederick, MD; Waldorf, MD

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Newbridge Surgery Center at Prince Frederick LLCCCN 21C0001517
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2026051Newbridge Surgery Center at Prince Frederick, LLC80 Sherry Lane, Suite 101, Prince Frederick, MD 20678Certificate of waiverJun 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Spine Pain Clinic of North2 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.

Locations

80 Sherry Ln
Ste 201
Prince Frederick, MD 20678

80 Sherry Ln
#101B
Prnc Frederck, MD 20678
Phone (410) 414-9229

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1285944504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR",
            "address_2": "SUITE 215",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024397",
            "telephone_number": "301-668-9988",
            "fax_number": "301-668-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SHERRY LN STE 101B",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206783232",
            "telephone_number": "410-414-9229",
            "fax_number": "410-414-9339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "GONCHIGAR",
        "authorized_official_first_name": "MRUTHYUNJAYA",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "301-461-6687",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.