Active NPI
Mira Mace Medical Group PA
- Family Medicine Physician
- North Bethesda, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MIRA MACE MEDICAL GROUP PA
- Practice address
- 11810 Grand Park Ave Ste 500
North Bethesda, MD 20852-8679 - Phone
- (332) 296-0021
- NPI assigned
- Aug 21, 2025
- Last updated
- Jun 3, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Prashant Kumar
- Title
- Operations Administrator
- Phone
- (332) 296-0021
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
11810 Grand Park Ave Ste 500
North Bethesda, MD 20852-8679
Mailing address
1111B S Governors Ave Ste 39475
Dover, DE 19904-6903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, GA, NH, FL, CO, WA, IL, IN, PA, DC, MO, OH, MN, SC, OK, TN, NC, MD, AZ, NJ
Enrollment records 20
National Provider Directory
National Provider DirectoryLocations
4041 E Thomas Rd
Ste 200
Phoenix, AZ 85018
6312 S Fiddlers Green Cir
#200
Greenwood Village, CO 80111
1111B S Governors Ave
Ste 39475
Dover, DE 19904
Phone (332) 296-0021
863 Massachusetts Ave
Fl 2
Indianapolis, IN 46204
Phone (317) 742-2738
500 Commonwealth Ave
#526
Boston, MA 02215
Phone (508) 293-1882
Practitioners & affiliated clinicians
Practitioners 5
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.
-
- Family Medicine Physician
- High Point, NC
- NPI 1336282011
AZ, CO, GA, NH, SC, TX, WA
-
- Family Medicine Physician
- Venice, CA
- NPI 1245233717
AZ, DC, FL, GA, IL, IN, MD, MN, MO, NC, OH, OK, PA, SC, TN, TX
-
- Nurse Practitioner
- Dracut, MA
- NPI 1033589858
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755734400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1780444800000",
"number": "1487532289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111B S GOVERNORS AVE STE 39475",
"city": "DOVER",
"state": "DE",
"postal_code": "199046903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11810 GRAND PARK AVE STE 500",
"city": "NORTH BETHESDA",
"state": "MD",
"postal_code": "208528679",
"telephone_number": "332-296-0021"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MIRA MACE MEDICAL GROUP PA",
"organizational_subpart": "NO",
"enumeration_date": "2025-08-21",
"last_updated": "2026-06-03",
"certification_date": "2026-06-03",
"status": "A",
"authorized_official_last_name": "KUMAR",
"authorized_official_first_name": "PRASHANT",
"authorized_official_title_or_position": "OPERATIONS ADMINISTRATOR",
"authorized_official_telephone_number": "332-296-0021"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in North Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; 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.