NPIMap

Organization Active NPI

Maryland Imaging Network PC

  • Diagnostic Radiology Physician
  • Prince Frederick, MD
National Provider Identifier
1316793391
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MARYLAND IMAGING NETWORK PC
Practice address
100 Hospital Rd
Prince Frederick, MD 20678-4017
Phone
(443) 436-1221
Fax
(443) 436-1256
NPI assigned
Apr 29, 2024
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MARYLAND IMAGING NETWORK PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
John Vernon Crues
Title
Owner
Phone
(443) 436-1116

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X NU
Diagnostic Radiology Physician 2085R0202X NU Primary
Vascular & Interventional Radiology Physician 2085R0204X NU

Addresses

Primary practice location

100 Hospital Rd
Prince Frederick, MD 20678-4017

Mailing address

10461 Mill Run Cir Ste 1200
Owings Mills, MD 21117-4204
Phone (443) 436-1221

Other names 1

  • MIN CHMC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191202001049 MD Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 71 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Glen Burnie, MD; Highland, MD; Laurel, MD; Lutherville Timonium, MD; New Market, MD; North Beach, MD; Prince Frederick, MD…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Maryland Imaging Network PC8 organizations share this tax ID, including this one
Part of
Maryland Imaging Network PC

Other organizations with this tax ID 7

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

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.

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": "1714348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1316793391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 MILL RUN CIR STE 1200",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174204",
            "telephone_number": "443-436-1221",
            "fax_number": "443-436-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL RD",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206784017",
            "telephone_number": "443-436-1221",
            "fax_number": "443-436-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND IMAGING NETWORK PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYLAND IMAGING NETWORK PC",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "CRUES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-436-1116"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIN CHMC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 29, 2024; 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.