NPIMap

Maryland Imaging Network PC

Organization Active NPI Diagnostic Radiology Physician · Prince Frederick, MD

NPI 1487296471 · NPPES record last updated Apr 9, 2024

Key facts

NPI
1487296471
Entity type
Organization (NPI type 2)
Primary specialty
Diagnostic Radiology Physician 2085R0202X
Legal business name
MARYLAND IMAGING NETWORK PC
Practice address
130 Hospital Rd Ste Ll100
Prince Frederick, MD 20678-4029
Phone
(410) 298-0454
Fax
(301) 694-2606
NPI assigned
Oct 11, 2019
Organization subpart
No

Authorized official

Name
John V. Crues, MD NPI 1255333480
Title
President and Owner
Phone
(310) 445-4800

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Subparts reporting this organization as parent 8

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners 141

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 141

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2232055Maryland Imaging Network
130 Hospital Road #Ll100, Prince Frederick, MD 20678		Certificate of waiverAug 9, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (25 enrollments) in MD, SC, DE, DC, CA, FL, NY, NC, IL, VA, NJ, PA, MA, TX, UT, ID, MO, GA, OH, CT, MI, MS, OR, PR, IN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20191202001049 MD Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 71 practitioners
8 other NPIs on this enrollment
Practice locations: Frederick, MD; Glen Burnie, MD; Highland, MD; Laurel, MD; Lutherville Timonium, MD; New Market, MD; North Beach, MD; Prince Frederick, MD…
O20200518003038 SC Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Columbia, SC; Johns Island, SC
O20201217001367 DE Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 4 practitioners
Practice locations: Newark, DE; Wilmington, DE
O20221130002395 DC Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 42 practitioners
1 other NPI on this enrollment
Practice locations: Potomac, MD; Washington, DC; Rockville, MD; Silver Spring, MD; Upper Marlboro, MD; Vienna, VA; Alexandria, VA; Arlington, VA…
O20230113000221 CA Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: San Diego, CA; Upland, CA
O20230228002017 FL Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 6 practitioners
Practice locations: Wesley Chapel, FL; Pensacola Beach, FL; North Miami, FL; Naples, FL; Englewood, FL; Bonita Springs, FL
O20230327002436 NY Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 8 practitioners
Practice locations: Rye, NY; Staten Island, NY; New York, NY; New Rochelle, NY; Long Island City, NY; Fayetteville, NY; East Syracuse, NY; East Setauket, NY…
O20230404001824 NC Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Norwood, NC; Supply, NC
O20230512001090 IL Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Chicago, IL; Winnetka, IL
O20230601000340 VA Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Winchester, VA; Virginia Beach, VA; Henrico, VA
O20230710003841 NJ Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 8 practitioners
Practice locations: West Caldwell, NJ; Verona, NJ; Short Hills, NJ; Nutley, NJ; North Caldwell, NJ; Livingston, NJ; Jersey City, NJ; Hoboken, NJ…
O20231127000023 PA Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Downingtown, PA; Mechanicsburg, PA
O20231130000149 MA Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Needham, MA
O20231202000608 TX Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 4 practitioners
Practice locations: Alamo Heights, TX; Austin, TX; Houston, TX; Missouri City, TX
O20231212001964 UT Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Salt Lake City, UT
O20231228000865 ID Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Boise, ID
O20240104003282 MO Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Kansas City, MO
O20240131001545 GA Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Saint Simons Island, GA; Suwanee, GA
O20240327002575 OH Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Powell, OH
O20240806001382 CT Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Greenwich, CT; Riverside, CT
O20240923000394 MI Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 2 practitioners
Practice locations: Ann Arbor, MI; Lake Orion, MI
O20241022003306 MS Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 3 practitioners
Practice locations: Jackson, MS; Madison, MS
O20250422000476 OR Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Oswego, OR
O20250618002948 PR Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 1 practitioner
Practice locations: San Juan, PR
O20260204001965 IN Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 3 practitioners
Practice locations: Indianapolis, IN; Carmel, IN; Zionsville, IN

National Provider Directory

Locations

6 Omega Dr
Newark, DE 19713
Phone (302) 738-9300

2055 Limestone Rd
Ste 104
Wilmington, DE 19808
Phone (302) 633-6200

837 5th Ave S
Ste 201
Naples, FL 34102

200 Hospital Dr
Ste 112
Glen Burnie, MD 21061
Phone (410) 768-5555

230 W Dares Beach Rd
Ste 100106
Prince Frederick, MD 20678
Phone (301) 855-9754

230 W Dares Beach Rd
Ste 106
Prince Frederick, MD 20678
Phone (410) 414-3437

1400 Forest Glen Rd
Ste 430
Silver Spring, MD 20910
Phone (301) 681-9100

11335 Pembrooke Sq
Ste 104
Waldorf, MD 20603

7253 Ambassador Rd
Windsor Mill, MD 21244
Phone (410) 281-9191

20 High St
Nutley, NJ 07110
Phone (973) 281-1881

333 S State St
Unit 244
Lake Oswego, OR 97034

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2085R0202X Yes

Addresses

Primary practice location

130 Hospital Rd Ste Ll100
Prince Frederick, MD 20678-4029

Mailing address

10461 Mill Run Cir Ste 1200
Owings Mills, MD 21117-4204
Phone (443) 436-1116

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 9, 2024.

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1487296471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 MILL RUN CIR STE 1200",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174204",
            "telephone_number": "443-436-1116",
            "fax_number": "443-436-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HOSPITAL RD STE LL100",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206784029",
            "telephone_number": "410-298-0454",
            "fax_number": "301-694-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND IMAGING NETWORK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "CRUES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PRESIDENT AND OWNER",
        "authorized_official_telephone_number": "310-445-4800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince Frederick, MD

All providers in Prince Frederick, MD · Diagnostic Radiology Physician in Maryland

Sources for this page

Verify at the official NPI Registry.