Active NPI
St. Clements Internal Medicine
- Nurse Practitioner
- Leonardtown, MD
National Provider Identifier
1306086848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R063357
- Legal business name
- ST. CLEMENTS INTERNAL MEDICINE
- Practice address
- 23130 Moakley St
Leonardtown, MD 20650-2918 - Phone
- (301) 997-1313
- Fax
- (301) 997-0709
- NPI assigned
- Feb 24, 2009
- Last updated
- Feb 24, 2009
- Organization subpart
- Yes
- Parent organization
- ST. CLEMENTS MEDICAL CARE, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Thomas M Wilkinson, M.D.
- Title
- Owner/Officer
- Phone
- (301) 997-0611
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R063357 | MD | Primary |
Addresses
Primary practice location
23130 Moakley St
Leonardtown, MD 20650-2918
Mailing address
40900 Merchants LN
Suite 207
Leonardtown, MD 20650-3700
Phone (301) 997-1580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143000900 | Medicaid | MD |
National Provider Directory
National Provider Directory- Part of
- St Clements Medical Car
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Family Medicine Physician
- Leonardtown, MD
- NPI 1982680641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235433600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1235433600000",
"number": "1306086848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40900 MERCHANTS LN",
"address_2": "SUITE 207",
"city": "LEONARDTOWN",
"state": "MD",
"postal_code": "206503700",
"telephone_number": "301-997-1580",
"fax_number": "301-997-0709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23130 MOAKLEY ST",
"city": "LEONARDTOWN",
"state": "MD",
"postal_code": "206502918",
"telephone_number": "301-997-1313",
"fax_number": "301-997-0709"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. CLEMENTS INTERNAL MEDICINE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST. CLEMENTS MEDICAL CARE, LLC",
"enumeration_date": "2009-02-24",
"last_updated": "2009-02-24",
"status": "A",
"authorized_official_last_name": "WILKINSON",
"authorized_official_first_name": "THOMAS",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OWNER/OFFICER",
"authorized_official_telephone_number": "301-997-0611",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": "MD",
"license": "R063357",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "143000900",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leonardtown, MD
- St Marys Hospital of St Marys County, Inc (Medstar St Marys Hospital Pharmacy)
- St Marys Pediatrics LLC
- St Marys Pharmacy LLC
- St Marys Pharmacy LLC
- St Marys Pharmacy LLC
- St. Clements Medical Care, LLC
- St. Mary's County Commissioners (St. Mary's County Dept of Emergency Services)
- St. Mary's County Health Department
- St. Mary's County Health Department
- St. Mary's County Public Schools
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.