Maryland Ambulatory Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MARYLAND AMBULATORY SURGERY CENTER LLC

Practice address

7501 Forbes Blvd Ste 103
Lanham, MD 20706-6201

Phone

(202) 498-1125

Fax

(240) 770-0436

NPI assigned

Mar 17, 2020

Last updated

Jun 30, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tristan ShockleyNPI 1932242542

Title

Owner

Phone

(301) 850-4401

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487280871. Details of each certification follow.

• CCN 21C0001634 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 21C0001634

Legal name

MARYLAND AMBULATORY SURGERY CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Feb 4, 2021

Last certification

Jan 22, 2021

Ownership / control type

Proprietary

Facility address

7501 Forbes Blvd. Suite 103
Lanham, MD 20706

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Tristan J Shockley, MD

  • Physical Medicine & Rehabilitation Physician
  • Laurel, MD
  • NPI 1932242542

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1487280871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 FORBES BLVD STE 103",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207066201",
            "telephone_number": "301-850-4401",
            "fax_number": "301-850-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 FORBES BLVD STE 103",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207066201",
            "telephone_number": "202-498-1125",
            "fax_number": "240-770-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND AMBULATORY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-17",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-850-4401"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tania Martinez-Equizabal
• Ingrid Maria Martinez, LCPC
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• Manka'a Mary Assumpta
• Fnu Mary Christy Kahma Fohtung
• Maryland CVS Pharmacy LLC (CVS Pharmacy # 03047)
• Maryland Oncology Hematology, P.a.
• Maryland Oncology Hematology, P.a.
• Maryland Sportscare & Rehab LLC (Pivot Physical Therapy of Maryland)
• Maryland Urgent Care (Sherif Hassan,MD)

• Ambulatory Surgical Clinic/Center in Lanham, MD
• Providers in Lanham, MD by specialty
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.