NPIMap

Organization Active NPI

Medstar Southern Maryland Hospital Center Inc

Doing business as MedStar Southern Maryland Hospital

  • General Acute Care Hospital
  • Clinton, MD
National Provider Identifier
1366790693
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER INC
Doing business as
MedStar Southern Maryland Hospital
MedStar Southern Maryland Hospital Center
Practice address
7503 Surratts Rd
Clinton, MD 20735-3358
Phone
(301) 868-8000
NPI assigned
Aug 16, 2012
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Mr. Michael Meisel
Title
Chief Financial Officer
Phone
(301) 475-6003

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

7503 Surratts Rd
Clinton, MD 20735-3358

Mailing address

7503 Surratts Rd
Clinton, MD 20735-3358

Other names 2

  • MedStar Southern Maryland Hospital Doing business as
  • MedStar Southern Maryland Hospital Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120904000213 MD Part A Provider - Hospital 1658528278 Practice locations: Clinton, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366790693. Details of each certification follow.

Hospital certification: CCN 210062

Legal name
MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Dec 17, 2012
Last certification
Dec 17, 2012
Beds
239
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 2012 in MD
Enrollment address
7503 Surratts Rd
Clinton, MD 20735-3358
Main/Primary Hospital Location
Hospital subgroups
Acute care, Psychiatric unit

Care Compare: Hospital

Medicare Care Compare
Listed as
Medstar Southern Maryland Hospital CenterCCN 210062 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Medstar Southern Maryland Hospital Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Medstar Southern Maryland Hospital Center Inc. Organization, Clinton, MD Non-profit 5% Or Greater Direct Ownership Interest Dec 11, 2012 100%
Stephen T Michaels Individual Corporate Officer Jan 29, 2022
Corporate Director Jan 29, 2022
W-2 Managing Employee Jan 29, 2022
Operational/Managerial Control Jan 29, 2022
Sonya Williams Individual Corporate Director Jun 1, 2019
Thomas Graham Individual Corporate Director Oct 31, 2022
Kenneth a Samet Individual Corporate Officer Aug 1, 2012
Corporate Director Aug 1, 2012
David H Michael Individual Corporate Director Apr 4, 2024
Rosalind Bishop Individual Corporate Director Nov 1, 2016
Vennard Wright Individual Corporate Officer Apr 4, 2024
Seema Pai Individual Corporate Director Jan 1, 2025
Gregory S Proctor Individual Corporate Director Apr 3, 2025
Mary Joy Maxwell Individual Corporate Director Aug 1, 2012
W-2 Managing Employee Aug 1, 2012
Clyde W Pray Individual Corporate Director Dec 9, 2021
Purvi Jani Individual Corporate Officer Jul 25, 2023
W-2 Managing Employee Jul 25, 2023
Operational/Managerial Control Jul 25, 2023
Kerry Watson Individual Corporate Director Sep 1, 2018
Medstar Health, Inc. Organization, Columbia, MD Non-profit 5% Or Greater Indirect Ownership Interest Dec 11, 2012 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

Practitioners & affiliated clinicians

Practitioners 70

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 70

Affiliated clinicians 490

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 490

NPI Registry JSON

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1366790693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7503 SURRATTS RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7503 SURRATTS RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353358",
            "telephone_number": "301-868-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "MEISEL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-475-6003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd Ste 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MedStar Southern Maryland Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedStar Southern Maryland Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedStar Southern Maryland Hospital Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, MD

Sources for this page

Verify at the official NPI Registry.