NPIMap

Organization Active NPI

Meritus Medical Center Inc

Doing business as Meritus Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Hagerstown, MD
National Provider Identifier
1295782910
Registry record updated Jul 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
D0042030 Issued in MD
Legal business name
MERITUS MEDICAL CENTER INC
Doing business as
Meritus Endocrinology
Practice address
11110 Medical Campus Rd
Suite 108
Hagerstown, MD 21742-6700
Phone
(301) 714-4041
Fax
(301) 714-4351
NPI assigned
May 28, 2006
Last updated
Jul 3, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MERITUS MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 3, 2013

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

Authorized official

Name
Ms. Vickie L Leach
Title
Business Manager
Phone
(301) 714-4041

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R175330 MD
Metabolic Nutrition Registered Dietitian 133VN1006X D02116 MD
Metabolic Nutrition Registered Dietitian 133VN1006X D02101 MD
Diabetes Educator Registered Nurse 163WD0400X R072839 MD
Diabetes Educator Registered Nurse 163WD0400X R075263 MD
Diabetes Educator Registered Nurse 163WD0400X R082255 MD
Endocrinology, Diabetes & Metabolism Physician 207RE0101X D0042030 MD Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 108
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Rd
Suite 108
Hagerstown, MD 21742-6700
Phone (301) 714-4041

Other names 1

  • Meritus Endocrinology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000950 MD Part B Supplier - Clinic/Group Practice 7113811795 Receives reassigned benefits from 320 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fulton, MD; Ellicott City, MD; Hagerstown, MD; Severna Park, MD; Frederick, MD; Edgewater, MD; Cumberland, MD; Crownsville, MD…

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
21D1073069Meritus Endocrinology Specialist11110 Medical Campus Rd Suite 108, Hagerstown, MD 21742Certificate of waiverAug 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Washngton Co Hos Ass-Su40 organizations share this tax ID, including this one
Part of
Washngton Co Hos Ass-Su

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Locations

10715 Downsville Pike
Hagerstown, MD 21740

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372809600000",
    "number": "1295782910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 108",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-714-4041",
            "fax_number": "301-714-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 108",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-714-4041",
            "fax_number": "301-714-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERITUS MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERITUS MEDICAL CENTER INC",
        "enumeration_date": "2006-05-28",
        "last_updated": "2013-07-03",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "301-714-4041",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R175330",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "MD",
            "license": "D02116",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "MD",
            "license": "D02101",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MD",
            "license": "R072839",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MD",
            "license": "R075263",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MD",
            "license": "R082255",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MD",
            "license": "D0042030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meritus Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2013; 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.