NPIMap

Individual provider Active NPI

Mudusar I Raza, M.D.

  • Pulmonary Disease Physician
  • Hagerstown, MD
National Provider Identifier
1467562371
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
D66166 Issued in MD
Practice address
12821 Oak Hill Ave
Hagerstown, MD 21742-2940
Phone
(301) 733-0300
Fax
(301) 733-5773
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 053707 GA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X D66166 MD
Sleep Medicine (Internal Medicine) Physician 207RS0012X D66166 MD
Pulmonary Disease Physician 207RP1001X D66166 MD Primary

Addresses

Primary practice location

12821 Oak Hill Ave
Hagerstown, MD 21742-2940

Mailing address

12821 Oak Hill Ave
Hagerstown, MD 21742-2940
Phone (301) 733-0300

Other practice location 1

801 Toll House Ave Ste B2
Frederick, MD 21701-6110
Phone (240) 575-9032

Other identifiers 3

IdentifierTypeStateIssuer
91623801OtherMDCAREFIRST BCBS
413617900MedicaidMD
74960005OtherDCCAREFIRST BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080213000356 MD Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 8527163997 Reassigns benefits to 4 organizations
I20081030000829 DC Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 8527163997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Sleep Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians
Medical Practices of Antietam, LLCGroup PAC ID 2567353865, 229 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

12821 Oak Hill Ave
Hagerstown, MD 21742-2940
Phone (301) 733-0300

Hospital & facility affiliations

  • Meritus Medical Center Hospital, Hagerstown, MD, CCN 210001
  • Wellspan Waynesboro Hospital Hospital, Waynesboro, PA, CCN 390138

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D66166MDMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Community Physicians, Inc Current Accepting new patients
Medical Practices of Antietam, LLC CurrentSince May 15, 2022 Accepting new patients
Shock Trauma Associates, P.a. CurrentSince Aug 18, 2017 Accepting new patients
Lifebridge Community Physicians, Inc CurrentSince Dec 4, 2016 Accepting new patients
Medical Practices of Antietam LLC CurrentSince May 15, 2022 Accepting new patients
Lifebridge Community Physicians Inc CurrentSince Dec 4, 2016 Accepting new patients
Anacostia Medical Associates Critical Care Medicine CurrentSince Jul 20, 2019 Accepting new patients
Capital Critical Care, LLC Critical Care Medicine Past Accepting new patients
Ajit P Kuruvilla MD LLC Critical Care Medicine Past Accepting new patients
Augusta Inpatient Services, LLC Past Accepting new patients
Sunrise Medical Group, LLC Critical Care Medicine PastSince Aug 15, 1998 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Gaithersburg Critical Care Associates LLC Pulmonary Disease Past Accepting new patients
Augusta Specialty Hospitalists LLC Past Accepting new patients

Locations

4601 Martin Luther King Jr Ave SW
Washington, DC 20032
Phone (202) 373-5840

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

604 Solarex Ct
Unit 207
Frederick, MD 21703
Phone (240) 439-4344

400 W 7th St
Frederick, MD 21701
Phone (240) 566-3300

12821 Oak Hill Ave
Hagerstown, MD 21742
Phone (301) 733-0300

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

11110 Medical Campus Rd
Ste 224
Hagerstown, MD 21742
Phone (301) 665-4560

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

6569 N Charles St
Ste 505
Towson, MD 21204
Phone (443) 849-2196

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 14

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1467562371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12821 OAK HILL AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217422940",
            "telephone_number": "301-733-0300",
            "fax_number": "301-733-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12821 OAK HILL AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217422940",
            "telephone_number": "301-733-0300",
            "fax_number": "301-733-5773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Toll House Ave Ste B2",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217016110",
            "country_code": "US",
            "telephone_number": "240-575-9032",
            "fax_number": "240-575-9042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAZA",
        "first_name": "MUDUSAR",
        "middle_name": "I",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "053707",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MD",
            "license": "D66166",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MD",
            "license": "D66166",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MD",
            "license": "D66166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "91623801",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413617900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "74960005",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.