NPIMap

Organization Active NPI

Northwest Hospital Center, Inc

Doing business as NW Breast Care Ctr,Hospitalist,PA, SHS Plastics,Surgical House Staff

  • Hospitalist Physician
  • Randallstown, MD
National Provider Identifier
1508961988
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
03-004 Issued in MD
Legal business name
NORTHWEST HOSPITAL CENTER, INC
Doing business as
NW Breast Care Ctr,Hospitalist,PA, SHS Plastics,Surgical House Staff
Practice address
5401 Old Court Rd
Randallstown, MD 21133-5103
Phone
(410) 521-2200
NPI assigned
Sep 13, 2006
Last updated
Oct 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Authorized official

Name
Mr. David McCormick
Title
Cfo
Phone
(410) 701-4618

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 03-004 MD
Internal Medicine Physician 207R00000X 03-004 MD
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 03-004 MD
Hematology & Oncology Physician 207RH0003X NU
Pulmonary Disease Physician 207RP1001X 03-004 MD
Plastic Surgery Physician 208200000X 03-004 MD
Surgery Physician 208600000X 03-004 MD
Hospitalist Physician 208M00000X 03-004 MD Primary

Addresses

Primary practice location

5401 Old Court Rd
Randallstown, MD 21133-5103

Mailing address

5401 Old Court Rd
Attn: Credentialing
Randallstown, MD 21133-5103
Phone (410) 601-5524

Other identifiers 1

IdentifierTypeStateIssuer
CN6601OtherMDR/R MEDICARE GROUP #

Other names 1

  • NW Breast Care Ctr,Hospitalist,PA, SHS Plastics,Surgical House Staff Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000328 MD Part B Supplier - Clinic/Group Practice 6204739352 Receives reassigned benefits from 289 practitioners
5 other NPIs on this enrollment
Practice locations: Randallstown, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 296

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.

View all 296

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1508961988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "address_2": "ATTN: CREDENTIALING",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "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": "5401 OLD COURT RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-521-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST HOSPITAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "410-701-4618",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "03-004",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "03-004",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MD",
            "license": "03-004",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MD",
            "license": "03-004",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MD",
            "license": "03-004",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "03-004",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MD",
            "license": "03-004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R/R MEDICARE GROUP #",
            "identifier": "CN6601",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW Breast Care Ctr,Hospitalist,PA, SHS Plastics,Surgical House Staff",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NW Breast Care Ctr,Hospitalist,PA, SHS Plastics,Surgical House Staff",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Randallstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.