NPIMap

Organization Active NPI

Medical Practices of Antietam, LLC

Doing business as Meritus Cosmetic and Plastic Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Hagerstown, MD
National Provider Identifier
1518686229
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MEDICAL PRACTICES OF ANTIETAM, LLC
Doing business as
Meritus Cosmetic and Plastic Surgery Center
Practice address
11110 Medical Campus Rd Ste 241
Hagerstown, MD 21742-6756
Phone
(301) 714-4460
NPI assigned
Aug 25, 2022
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Authorized official

Name
Joshua Repac
Title
Cfo
Phone
(301) 790-9351

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Point of Service 305S00000X

Addresses

Primary practice location

11110 Medical Campus Rd Ste 241
Hagerstown, MD 21742-6756

Mailing address

11110 Medical Campus Rd Ste 241
Hagerstown, MD 21742-6756

Other names 1

  • Meritus Cosmetic and Plastic Surgery Center Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518686229. Details of each certification follow.

Ambulatory surgical center certification: CCN 21C0001227

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COSMETIC PLASTIC SURGERY CENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Feb 7, 1997
Last certification
Nov 21, 2019
Ownership / control type
Proprietary
Facility address
11110 Medical Campus Road, Suite #241
Hagerstown, MD 21742

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2292382Meritus Cosmetic & Plastic Surgery11110 Medical Campus Rd Suite 241, Hagerstown, MD 21742Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medical Pratices of Ant63 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1518686229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 241",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 241",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426756",
            "telephone_number": "301-714-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PRACTICES OF ANTIETAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-25",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "REPAC",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-790-9351"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meritus Cosmetic and Plastic Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.