NPIMap

Organization Active NPI

Baltimore Medical System Inc

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
National Provider Identifier
1396366308
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BALTIMORE MEDICAL SYSTEM INC
Practice address
1000 E Eager St
Baltimore, MD 21202-5533
Phone
(410) 522-9800
NPI assigned
Apr 30, 2020
Reactivated
Jun 1, 2023
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Shirley Sutton
Title
President/Ceo
Phone
(410) 558-4891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1000 E Eager St
Baltimore, MD 21202-5533

Mailing address

5525 Eastern Ave Ste 301
Baltimore, MD 21224-2796
Phone (410) 558-4890

Other names 1

  • East Baltimore Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200514000823 MD Part A Provider - Federally Qualified Health Center (FQHC) 5395653455 Practice locations: Baltimore, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396366308. Details of each certification follow.

Federally qualified health center certification: CCN 211931

Legal name
BALTIMORE MEDICAL SYSTEM, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 15, 2020
Last certification
May 15, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1985 in MD
Enrollment address
1000 E Eager St
Baltimore, MD 21202-5533

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Baltimore Medical System Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Shirley Sutton Individual Corporate OfficerChief Executive Officer Mar 1, 2015
Allison Mackenzie Individual Corporate OfficerBoard Member Jul 27, 2015
Sarah Norman Individual Corporate OfficerBoard Member Feb 25, 2013
Yolanda Copeland Individual Corporate OfficerBoard Member Dec 19, 2016
Christopher Demarco Individual Corporate OfficerBoard Member Jan 1, 2018
Cheryl Bryant Individual Corporate OfficerBoard Member Aug 24, 2015
Rebecca Dawson Individual W-2 Managing EmployeeRevenue Cycle Manager Jan 1, 2021
Margaret Boemmel Individual Operational/Managerial ControlCfo Dec 16, 2019
Scarlett Watson Individual Corporate OfficerBoard Member May 1, 2015
Michael Banfield Individual Corporate OfficerBoard Member Jan 23, 2017
David Sheehy Individual Corporate OfficerBoard Member Mar 26, 2012
Arif Khan Individual Corporate OfficerBoard Member Dec 19, 2016
Christina McWilliams Individual Corporate OfficerBoard Member Aug 24, 2015

NPI Registry JSON

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

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1396366308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 EASTERN AVE STE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242796",
            "telephone_number": "410-558-4890",
            "fax_number": "410-587-2386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E EAGER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212025533",
            "telephone_number": "410-522-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALTIMORE MEDICAL SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-30",
        "last_updated": "2025-09-02",
        "certification_date": "2024-02-02",
        "deactivation_date": "2023-05-13",
        "reactivation_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "410-558-4891"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Baltimore Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.