NPIMap

Organization Active NPI

Asbury Atlantic, Inc

  • Physical Therapist
  • Gaithersburg, MD
National Provider Identifier
1558086587
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ASBURY ATLANTIC, INC
Practice address
301 Russell Ave
Gaithersburg, MD 20877-2807
Phone
(301) 250-2105
NPI assigned
Oct 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Magdalene Olsen
Title
Legal & Compliance Program Coord.
Phone
(301) 250-2105

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

301 Russell Ave
Gaithersburg, MD 20877-2807

Mailing address

5285 Westview Dr Ste 200
Frederick, MD 21703-8521
Phone (301) 250-2105

Other identifiers 1

IdentifierTypeStateIssuer
790008200MedicaidMD

Other names 1

  • Asbury Methodist Village Doing business as

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
21D0212852Wilson Health Care Center Asbury Methodist Village301 Russell Ave, Gaithersburg, MD 20877Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Asbury Atlantic Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5285 Westview Dr
Ste 200
Frederick, MD 21703

NPI Registry JSON

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1558086587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5285 WESTVIEW DR STE 200",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217038521",
            "telephone_number": "301-250-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 RUSSELL AVE",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772807",
            "telephone_number": "301-250-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASBURY ATLANTIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "MAGDALENE",
        "authorized_official_title_or_position": "LEGAL & COMPLIANCE PROGRAM COORD.",
        "authorized_official_telephone_number": "301-250-2105"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790008200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Asbury Methodist Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.