NPIMap

Organization Active NPI

St Paul Place Specialists, Inc.

  • Rheumatology Physician
  • Baltimore, MD
National Provider Identifier
1497796775
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
ST PAUL PLACE SPECIALISTS, INC.
Practice address
301 St. Paul Place
Pob 411
Baltimore, MD 21202-2102
Phone
(410) 332-9346
Fax
(410) 385-2354
NPI assigned
Jun 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Justin Deibel
Title
Executive Vice President & Cfo
Phone
(410) 659-2905

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X MD
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X MD Primary

Addresses

Primary practice location

301 St. Paul Place
Pob 411
Baltimore, MD 21202-2102

Mailing address

PO Box 824173
Philadelphia, PA 19182-4173

Other identifiers 2

IdentifierTypeStateIssuer
S186OtherMDBLUECHOICE
KAZ1OtherMDBC / BS OF MD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031202000084 MD Part B Supplier - Clinic/Group Practice 7719882943 Receives reassigned benefits from 568 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Towson, MD; Baltimore, MD; Randallstown, MD; Pikesville, MD; Lutherville Timonium, MD; Lutherville, MD; Laurel, MD; Glen Burnie, MD…
O20120605000602 DC Part B Supplier - Clinic/Group Practice 7719882943 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alexandria, VA; Washington, DC; Reston, VA; Kensington, MD; Fairfax, VA
O20220613001806 FL Part B Supplier - Clinic/Group Practice 7719882943 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gulf Breeze, FL; Celebration, FL; Estero, FL; Aventura, FL; Clermont, FL

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 58

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

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1497796775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824173",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191824173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ST. PAUL PLACE",
            "address_2": "POB 411",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022102",
            "telephone_number": "410-332-9346",
            "fax_number": "410-385-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PAUL PLACE SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "DEIBEL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "410-659-2905"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHOICE",
            "identifier": "S186",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC / BS OF MD",
            "identifier": "KAZ1",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.