NPIMap

Organization Active NPI

Centennial Medical Group, PA

  • General Practice Physician
  • Gambrills, MD
National Provider Identifier
1306477849
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CENTENNIAL MEDICAL GROUP, PA
Practice address
1071 MD RT 3 N Ste 101
Gambrills, MD 21054-1784
Phone
(410) 721-2333
NPI assigned
Feb 3, 2020
Last updated
Feb 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTENNIAL MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
Ron Elfenbein, MD
Title
Medical Director
Phone
(410) 721-2333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

1071 MD RT 3 N Ste 101
Gambrills, MD 21054-1784

Mailing address

5005 Signal Bell LN Ste 200
Clarksville, MD 21029-2608
Phone (410) 730-3399

Other names 1

  • Centennial Medical Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040409000473 MD Part B Supplier - Clinic/Group Practice 2668466038 Receives reassigned benefits from 61 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksville, MD; Laurel, MD; Gambrills, MD; Ellicott City, MD; Elkridge, MD; Columbia, MD

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Invalid Record8 organizations share this tax ID, including this one
Part of
Invalid Record

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1306477849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5005 SIGNAL BELL LN STE 200",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210292608",
            "telephone_number": "410-730-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 MD RT 3 N STE 101",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541784",
            "telephone_number": "410-721-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTENNIAL MEDICAL GROUP",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "ELFENBEIN",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "410-721-2333",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centennial Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gambrills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; 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.