Greater Baltimore Medical Center, Inc.
Organization Active NPI Family Medicine Physician · Phoenix, MD
NPI 1447072848 · NPPES record last updated Oct 28, 2024
Key facts
- NPI
- 1447072848
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- GREATER BALTIMORE MEDICAL CENTER, INC.
- Practice address
- 3346 Paper Mill Rd
Phoenix, MD 21131-1419 - Phone
- (410) 666-4060
- NPI assigned
- Oct 28, 2024
- Organization subpart
- No
Authorized official
- Name
- Laurie R Beyer
- Title
- Evp & Cfo
- Phone
- (443) 849-2519
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D0215692 | GBMC at Hunt Manor | Certificate of waiver | Aug 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040217000852 | MD | Part B Supplier - Clinic/Group Practice | 1759276975 |
Receives reassigned benefits from 513 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- GB Head and Neck Assoc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
3346 Paper Mill Rd
Phoenix, MD 21131-1419
Mailing address
6701 N Charles Street
South Chapman Building, Suite 102
Baltimore, MD 21204
Phone (443) 849-2435
Other names
- GBMC at Hunt Manor
Other providers in Phoenix, MD
- Family Foot and Ankle Care, PC
- Magdalena Felton
- Kerry Elisabeth Fitzpatrick
- April Christine Fogg
- Fred Hillwig, Psy.D., P.a.
- He Supplier
- Heartwood Counseling & Wellness LLC
- Amanda Hessinger
- Alfred J. Hillwig
- Gina Hoag
All providers in Phoenix, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.