NPIMap

Organization Active NPI

Opal Medical Group, P.a.

  • Internal Medicine Physician
  • Hagerstown, MD
National Provider Identifier
1477639862
Registry record updated Feb 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D52323 Issued in MD
Legal business name
OPAL MEDICAL GROUP, P.A.
Practice address
1126 Opal Court
Hagerstown, MD 21740
Phone
(240) 420-2666
Fax
(240) 420-0951
NPI assigned
Oct 27, 2006
Last updated
Feb 24, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2010

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

Authorized official

Name
Mrs. Amy Renee Hose
Title
Office Manager
Phone
(240) 420-6909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D52323 MD Primary

Addresses

Primary practice location

1126 Opal Court
Hagerstown, MD 21740

Mailing address

1126 Opal Court
Hagerstown, MD 21740
Phone (240) 420-2666

Other identifiers 1

IdentifierTypeStateIssuer
404343000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040102000138 MD Part B Supplier - Clinic/Group Practice 1658270301 Receives reassigned benefits from 9 practitioners
Practice locations: Hagerstown, MD
O20070110000208 WV Part B Supplier - Clinic/Group Practice 1658270301 Receives reassigned benefits from 4 practitioners
Practice locations: Charles Town, WV

National Provider Directory

National Provider Directory

Locations

1126 Opal Ct
Hagerstown, MD 21740
Phone (240) 420-0950

2720 Charles Town Rd
Martinsburg, WV 25405
Phone (304) 262-8686

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": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266969600000",
    "number": "1477639862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 OPAL COURT",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "21740",
            "telephone_number": "240-420-2666",
            "fax_number": "240-420-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 OPAL COURT",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "21740",
            "telephone_number": "240-420-2666",
            "fax_number": "240-420-0951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPAL MEDICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2010-02-24",
        "status": "A",
        "authorized_official_last_name": "HOSE",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "240-420-6909",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D52323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404343000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; 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.