NPIMap

Organization Active NPI

Calverthealth Medical Center, Inc.

Doing business as CalvertHealth Outpatient Rehabilitation Prince Frederick

  • Physical Therapy Clinic/Center
  • Prince Frederick, MD
National Provider Identifier
1558718668
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
CALVERTHEALTH MEDICAL CENTER, INC.
Doing business as
CalvertHealth Outpatient Rehabilitation Prince Frederick
Practice address
130 Hospital Rd
Suite 103
Prince Frederick, MD 20678-4015
Phone
(410) 535-8180
Fax
(410) 535-8325
NPI assigned
May 18, 2016
Last updated
Jan 24, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
CALVERT HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

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

Authorized official

Name
Dean Teague
Title
President/Ceo
Phone
(410) 535-8239

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary
Occupational Therapy Assistant 224Z00000X
Physical Therapist 225100000X
Physical Therapy Assistant 225200000X
Occupational Therapist 225X00000X

Addresses

Primary practice location

130 Hospital Rd
Suite 103
Prince Frederick, MD 20678-4015

Mailing address

100 Hospital Rd
Att: Contract & Credentialing
Prince Frederick, MD 20678-4017
Phone (410) 414-4791

Other identifiers 1

IdentifierTypeStateIssuer
728804202MedicaidMD

Other names 1

  • CalvertHealth Outpatient Rehabilitation Prince Frederick Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161103002598 MD DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 2668370065 Practice locations: Prince Frederick, MD
O20161221001977 MD Part B Supplier - Hospital Department(S) 2668370065 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
Practice locations: Dunkirk, MD; Prince Frederick, MD; Solomons, MD

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Calverthealth Med Ctr 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.

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1558718668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL RD",
            "address_2": "ATT: CONTRACT & CREDENTIALING",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206784017",
            "telephone_number": "410-414-4791",
            "fax_number": "410-414-4558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HOSPITAL RD",
            "address_2": "SUITE 103",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206784015",
            "telephone_number": "410-535-8180",
            "fax_number": "410-535-8325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALVERTHEALTH MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALVERT HEALTH SYSTEM, INC.",
        "enumeration_date": "2016-05-18",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "410-535-8239"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "728804202",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CalvertHealth Outpatient Rehabilitation Prince Frederick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prince Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; 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.