NPIMap

Organization Active NPI

St. Mary's Multi-Specialty Surgery Centre, Inc.

  • Ambulatory Surgical Clinic/Center
  • Great Mills, MD
National Provider Identifier
1295750594
Registry record updated Oct 23, 2008
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 MULTI-SPECIALTY SURGERY CENTRE, INC.
Practice address
22325 Greenview Pkwy
Great Mills, MD 20634-4404
Phone
(301) 862-3338
Fax
(301) 862-3335
NPI assigned
Jul 13, 2006
Last updated
Oct 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

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

Authorized official

Name
Dr. Douglas Hallgren, D.P.M.NPI 1336158955
Title
Director
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 20634-4404

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081113000580 MD Part B Supplier - Ambulatory Surgical Center 7517027048 Receives reassigned benefits from 1 practitioner
Practice locations: Great Mills, MD

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.

Locations

22325 Greenview Pkwy
Unit 1A
Great Mills, MD 20634
Phone (301) 862-3338

Practitioners & affiliated clinicians

Practitioners 2

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": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1295750594",
    "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": "206344404",
            "telephone_number": "301-862-3338",
            "fax_number": "301-862-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MULTI-SPECIALTY SURGERY CENTRE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "HALLGREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "DIRECTOR",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; 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.