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

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

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.

• 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
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• Maryland CVS Pharmacy LLC
• Maryland Oncology Hematology, P.a.
• Maryland Oncology Hematology, P.a.
• Maryland Sportscare & Rehab LLC
• Maryland Urgent Care

• All providers in Lanham, MD
• 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.
• 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.