Organization Active NPI

Ambulatory Surgery Center of Bethesda, LLC

  • Ambulatory Surgical Clinic/Center
  • North Bethesda, MD
National Provider Identifier
1407947112
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1371 Issued in MD
Legal business name
AMBULATORY SURGERY CENTER OF BETHESDA, LLC
Practice address
11210 Old Georgetown Rd
North Bethesda, MD 20852-3202
Phone
(301) 984-8600
Fax
(301) 984-8601
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Authorized official

Name
Dr. Douglas Forman, M.D.
Title
Medical Director
Phone
(301) 984-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A1371 MD Primary

Addresses

Primary practice location

11210 Old Georgetown Rd
North Bethesda, MD 20852-3202

Mailing address

11210 Old Georgetown Rd
North Bethesda, MD 20852-3202
Phone (301) 984-8600

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Ambulatory Surgery Center of BCCN 21C0001371
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2141878Ambulatory Surgery Center of Bethesda LLC11210 Old Georgetown Road, Rockville, MD 20852Certificate of waiverDec 25, 2027

National Provider Directory

National Provider Directory

Locations

11210 Old Georgetown Rd
Rockville, MD 20852
Phone (301) 881-7770

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777852800000",
    "number": "1407947112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11210 OLD GEORGETOWN RD",
            "city": "NORTH BETHESDA",
            "state": "MD",
            "postal_code": "208523202",
            "telephone_number": "301-984-8600",
            "fax_number": "301-984-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11210 OLD GEORGETOWN RD",
            "city": "NORTH BETHESDA",
            "state": "MD",
            "postal_code": "208523202",
            "telephone_number": "301-984-8600",
            "fax_number": "301-984-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBULATORY SURGERY CENTER OF BETHESDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A",
        "authorized_official_last_name": "FORMAN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-984-8600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.