NPIMap

Organization Active NPI

University of Maryland Family Medicine Associates, P.a.

  • Specialist
  • Baltimore, MD
National Provider Identifier
1417764010
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
UNIVERSITY OF MARYLAND FAMILY MEDICINE ASSOCIATES, P.A.
Practice address
408 W Lombard St
Baltimore, MD 21201-1601
Phone
(410) 328-6792
NPI assigned
Dec 17, 2024
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Shavonda L Williams
Title
Corp. Director
Phone
(667) 214-2507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

408 W Lombard St
Baltimore, MD 21201-1601

Mailing address

PO Box 64380
Baltimore, MD 21264-4380

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050422000217 MD Part B Supplier - Clinic/Group Practice 4183662851 Receives reassigned benefits from 85 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbia, MD; Baltimore, MD

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
University of Maryland Family Medicine Behavioral Health8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

29 S Paca St
Baltimore, MD 21201
Phone (410) 328-2603

36 S Paca St
Ste 113
Baltimore, MD 21201
Phone (410) 328-8669

Practitioners & affiliated clinicians

Practitioners 94

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 94

NPI Registry JSON

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

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1417764010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64380",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 W LOMBARD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011601",
            "telephone_number": "410-328-6792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MARYLAND FAMILY MEDICINE ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SHAVONDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CORP. DIRECTOR",
        "authorized_official_telephone_number": "667-214-2507"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.