Individual provider Active NPI

Andres R Lagoc, PA-C

  • Surgical Physician Assistant
  • Baltimore, MD
National Provider Identifier
1508887878
Registry record updated Oct 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
C0003101 Issued in MD
Practice address
2401 W Belvedere Ave
Rubin Institute for Advanced Orthopedics
Baltimore, MD 21215-5216
Phone
(410) 601-9440
Fax
(410) 601-1870
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0003101 MD
Surgical Physician Assistant 363AS0400X C0003101 MD Primary

Addresses

Primary practice location

2401 W Belvedere Ave
Rubin Institute for Advanced Orthopedics
Baltimore, MD 21215-5216

Mailing address

2401 W Belvedere Ave
Attn: Credentialing
Baltimore, MD 21215-5216
Phone (410) 601-5524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091009000359 MD Practitioner - Physician Assistant 3870639537 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Sinai Hospital of Baltimore, IncGroup PAC ID 0941112346, 373 clinicians

Practice addresses (Care Compare)

2401 E Belvedere Ave
Baltimore, MD 21215-5216

Hospital & facility affiliations

  • Sinai Hospital of Baltimore Hospital, Baltimore, MD, CCN 210012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sinai Hospital of Baltimore Inc CurrentSince Oct 20, 2010 Accepting new patients
Sinai Hospital of Baltimore, Inc. CurrentSince Oct 20, 2010 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2401 W Belvedere Ave
Baltimore, MD 21215

2435 W Belvedere Ave
Ste 56
Baltimore, MD 21215
Phone (410) 578-8632

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 and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255910400000",
    "number": "1508887878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W BELVEDERE AVE",
            "address_2": "ATTN: CREDENTIALING",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155216",
            "telephone_number": "410-601-5524",
            "fax_number": "410-601-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W BELVEDERE AVE",
            "address_2": "RUBIN INSTITUTE FOR ADVANCED ORTHOPEDICS",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155216",
            "telephone_number": "410-601-9440",
            "fax_number": "410-601-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGOC",
        "first_name": "ANDRES",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2009-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0003101",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0003101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.