Individual provider Active NPI

Mario Humberto Diaz, MD

  • Surgery Physician
  • Annapolis, MD
National Provider Identifier
1508803693
Registry record updated Sep 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
D0022049 Issued in MD
Practice address
2001 Medical Pkwy
Acp 4TH Floor/Surgical Hospitalist Ste.
Annapolis, MD 21401-3280
Phone
(443) 481-1372
Fax
(443) 481-1360
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X D0022049 MD Primary

Addresses

Primary practice location

2001 Medical Pkwy
Acp 4TH Floor/Surgical Hospitalist Ste.
Annapolis, MD 21401-3280

Mailing address

PO Box 64834
Baltimore, MD 21264-4834
Phone (443) 481-6573

Other identifiers 6

IdentifierTypeStateIssuer
4071161OtherAETNA PPO
6718667OtherAETNA HMO
89468104OtherCAREFIRST
K585007OtherCAREFIRST
145726104OtherFEDERAL DEPT OF LABOR (WORKMAN'S COMP)
112414OtherKAISER PERMANENTE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0022049MDMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Horizon Surgical Group, PA Past Accepting new patients
Horizon Surgical Group, PA PastSince Oct 1, 1998 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Anne Arundel Medical Center Inc Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284681600000",
    "number": "1508803693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64834",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644834",
            "telephone_number": "443-481-6573",
            "fax_number": "443-481-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MEDICAL PKWY",
            "address_2": "ACP 4TH FLOOR/SURGICAL HOSPITALIST STE.",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013280",
            "telephone_number": "443-481-1372",
            "fax_number": "443-481-1360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "MARIO",
        "middle_name": "HUMBERTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2010-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "D0022049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4071161",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "6718667",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "89468104",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "K585007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL DEPT OF LABOR (WORKMAN'S COMP)",
            "identifier": "145726104",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERMANENTE",
            "identifier": "112414",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.