Organization Active NPI

Carroll Primary Care, PA

  • Family Medicine Physician
  • Eldersburg, MD
National Provider Identifier
1427189174
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CARROLL PRIMARY CARE, PA
Practice address
1380 Progress Way
Suite 114
Eldersburg, MD 21784-6464
Phone
(410) 795-1888
Fax
(410) 795-3538
NPI assigned
Mar 7, 2007
Last updated
May 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2010

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

Authorized official

Name
Michael Keith McEvoy, M.D.NPI 1669558219
Title
V. President, Carroll Primary Care
Phone
(410) 798-1888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1380 Progress Way
Suite 114
Eldersburg, MD 21784-6464

Mailing address

1380 Progress Way
Suite 114
Eldersburg, MD 21784-6464
Phone (410) 795-1888

Other identifiers 1

IdentifierTypeStateIssuer
208571200MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040902000090 MD Part B Supplier - Clinic/Group Practice 2668447533 Receives reassigned benefits from 13 practitioners
Practice locations: Eldersburg, MD; Westminster, MD

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
21D0896228Carroll Primary Care PA1380 Progress Way Suite 114, Eldersburg, MD 21784Provider-performed microscopyJan 3, 2027

National Provider Directory

National Provider Directory

Locations

1380 Progress Way
Ste 114
Sykesville, MD 21784
Phone (410) 795-1888

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1427189174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 PROGRESS WAY",
            "address_2": "SUITE 114",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846464",
            "telephone_number": "410-795-1888",
            "fax_number": "410-795-3538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 PROGRESS WAY",
            "address_2": "SUITE 114",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846464",
            "telephone_number": "410-795-1888",
            "fax_number": "410-795-3538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLL PRIMARY CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "MCEVOY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "V. PRESIDENT, CARROLL PRIMARY CARE",
        "authorized_official_telephone_number": "410-798-1888",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208571200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.