John DO
Individual provider Active NPI Family Medicine Physician · Frederick, MD
NPI 1346990652 · NPPES record last updated Jul 7, 2025
Key facts
- NPI
- 1346990652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- H0102911 (MD)
- Practice address
- 141 Thomas Johnson Dr Ste 100
Frederick, MD 21702-4509 - Phone
- (301) 228-9123
- NPI assigned
- Mar 28, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Privia Care Center LLC
Practice addresses (Care Compare)
141 Thomas Johnson Dr
Suite 100
Frederick, MD 21702-4509
Phone (301) 228-9123
Hospital & facility affiliations
- Frederick Health Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250808000474 | MD | Practitioner - Family Practice | 6901288307 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H0102911 | MD | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Care Center LLC | Internal Medicine | Current |
Accepting new patients |
| Menocal Medical Services PA | Family Medicine | Current | Accepting new patients |
| Privia Care Center LLC | Internal Medicine | Current | Accepting new patients |
| Nova Physician Wellness Center PLLC | Family Medicine | Past | Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
110 Baughmans Ln
Ste 140
Frederick, MD 21702
Phone (240) 215-1138
141 Thomas Johnson Dr
Ste 100
Frederick, MD 21702
Phone (301) 228-9123
Interoperability endpoints
- https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
- john.do.p1@direct.nevadahealthcenters.nextgenshare.com
- john.do.1@8042.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | H0102911 | MD | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | H0102911 | MD | Yes |
Addresses
Primary practice location
141 Thomas Johnson Dr Ste 100
Frederick, MD 21702-4509
Mailing address
141 Thomas Johnson Dr Ste 100
Frederick, MD 21702-4509
Phone (240) 696-3927
Other practice location 1
9300 W Sunset Rd
Las Vegas, NV 89148-4844
Phone (702) 916-5000
Other providers in Frederick, MD
- Jennifer E Djanison
- DMV Allergy and Asthma Center LLC
- DNK Health LLC
- DNK Health LLC
- Chinh Cong DO
- Danielle M Doan
- Kathryn Taylor Dock
- Doctord,LLC
- Doctors First Professional Corporation
- Johanna M Dolan
All providers in Frederick, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.