South Mountain Family Practice LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

D0056826 Issued in MD

Legal business name

SOUTH MOUNTAIN FAMILY PRACTICE LLC

Practice address

9 Saint Paul St
Boonsboro, MD 21713-1334

Phone

(301) 432-0623

Fax

(301) 432-0624

NPI assigned

Jul 26, 2007

Last updated

Jun 29, 2011By 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

Dr. William F Bodenheimer III, MDNPI 1427010354

Title

Owner

Phone

(301) 432-0623

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

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.

• William Franklin Bodenheimer III, M.D.

  • Family Medicine Physician
  • Boonsboro, MD
  • NPI 1427010354
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309305600000",
    "number": "1487844593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 SAINT PAUL ST",
            "city": "BOONSBORO",
            "state": "MD",
            "postal_code": "217131334",
            "telephone_number": "301-432-0623",
            "fax_number": "301-432-0624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 SAINT PAUL ST",
            "city": "BOONSBORO",
            "state": "MD",
            "postal_code": "217131334",
            "telephone_number": "301-432-0623",
            "fax_number": "301-432-0624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2011-06-29",
        "status": "A",
        "authorized_official_last_name": "BODENHEIMER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-432-0623",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MD",
            "license": "D0056826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela M Sluzalis, LCSWC
• SM Rehab
• Aaron M. Smith, PTA
• Stephanie A Snyder, LCADC
• South Mountain Community Health LLC
• South Mountain Operator LLC
• South Mountain Operator LLC
• Spring Ridge Chiropractic of Boonsboro LLC
• Still Water Counseling Services, LLC
• Synergy Medical Group LLC

• Clinic/Center in Boonsboro, MD
• Providers in Boonsboro, MD by specialty
• Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; 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.