Deep Creek Colon and Rectal Surgery, PC

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

D0068477 Issued in MD

Legal business name

DEEP CREEK COLON AND RECTAL SURGERY, PC

Practice address

880 Memorial Dr
Oakland, MD 21550-5114

Phone

(301) 334-1066

Fax

(877) 504-1066

NPI assigned

Feb 9, 2018

Organization subpart

No

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

Authorized official

Name

Klaus Schmidt

Title

Practice Administrator

Phone

(301) 334-4340

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HGAEBD

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lynda S Dougherty, M.D.

  • Colon & Rectal Surgery Physician
  • Oakland, MD
  • NPI 1376534149
  Medicare reassignment NPD

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

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559174400000",
    "number": "1356840995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 MEMORIAL DR",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215505114",
            "telephone_number": "301-334-4340",
            "fax_number": "877-504-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 MEMORIAL DR",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215505114",
            "telephone_number": "301-334-1066",
            "fax_number": "877-504-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP CREEK COLON AND RECTAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-09",
        "last_updated": "2019-05-30",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "KLAUS",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "301-334-4340"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "MD",
            "license": "D0068477",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "MD",
            "license": "D0068477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa A Cussins
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• Tosin David
• Natasha Deen
• Michele Delalla, RN
• Dennett Road Manor Inc
• Dennett SNF
• Dennett SNF LLC
• Diakon Lutheran Social Ministries

• Colon & Rectal Surgery Physician in Oakland, MD
• Providers in Oakland, MD by specialty
• Colon & Rectal Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.