NPIMap

Organization Active NPI

DMV G-Angel Surgical Assist LLC

  • Surgical Assistant
  • Waldorf, MD
National Provider Identifier
1417861790
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical AssistantTaxonomy code 246ZC0007X
Legal business name
DMV G-ANGEL SURGICAL ASSIST LLC
Practice address
2453 Kenbrook CT
Waldorf, MD 20603-3227
Phone
(301) 257-6191
NPI assigned
Oct 1, 2026
Last updated
Oct 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

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

Authorized official

Name
Mr. Jacques Emile Bussiere, LSA, CSANPI 1366917627
Title
Founder and Managing Member
Phone
(301) 257-6191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Assistant 246ZC0007X NU Primary

Addresses

Primary practice location

2453 Kenbrook CT
Waldorf, MD 20603-3227

Mailing address

2453 Kenbrook CT
Waldorf, MD 20603-3227
Phone (301) 257-6191

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1790812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790812800000",
    "number": "1417861790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2453 KENBROOK CT",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206033227",
            "telephone_number": "301-257-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2453 KENBROOK CT",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206033227",
            "telephone_number": "301-257-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DMV G-ANGEL SURGICAL ASSIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-01",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A",
        "authorized_official_last_name": "BUSSIERE",
        "authorized_official_first_name": "JACQUES EMILE",
        "authorized_official_title_or_position": "FOUNDER AND MANAGING MEMBER",
        "authorized_official_telephone_number": "301-257-6191",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LSA, CSA"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.