NPIMap

Individual provider Active NPI

Edgar F Peithman, P.A.

  • Physician Assistant
  • La Plata, MD
National Provider Identifier
1396745691
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C01172 Issued in MD
Practice address
701 Charles St
La Plata, MD 20646-5930
Phone
(301) 609-4000
NPI assigned
Jul 28, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C01172 MD Primary

Addresses

Primary practice location

701 Charles St
La Plata, MD 20646-5930

Mailing address

127 Tanners Point Dr
Stevensville, MD 21666-3701
Phone (410) 643-1734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040423000337 MD Practitioner - Physician Assistant 5698761799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tamy B. Buckel, M.D., P.a.Group PAC ID 0840293478, 3 clinicians

Practice addresses (Care Compare)

100 Bramble St
Suite a
Cambridge, MD 21613-2471
Phone (410) 228-8106

250 Haacke Dr
Chestertown, MD 21620-1193
Phone (410) 778-0003

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C01172MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chesapeake Laser & Skin Care Past Accepting new patients
PA Surgical Services, LLC Past Accepting new patients
Greater Washington Emergency Physicians Chartered Past Accepting new patients
Kenneth P. Judd, M.D., PH.D. and Associates LLC Past Accepting new patients
Tamy B. Buckel, M.D., P.a. Past Accepting new patients
The Pediatric Group and Families Too, LLC Past Accepting new patients
Johns Hopkins Community Physicians, Inc Past Accepting new patients
Riverside Primary Care Associates LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ep@shoredermatology.emadirect.md
  • Direct secure messaging: epeithman@directaddress.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396745691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 TANNERS POINT DR",
            "city": "STEVENSVILLE",
            "state": "MD",
            "postal_code": "216663701",
            "telephone_number": "410-643-1734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CHARLES ST",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465930",
            "telephone_number": "301-609-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEITHMAN",
        "first_name": "EDGAR",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C01172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

Verify at the official NPI Registry.