NPIMap

Organization Active NPI

Frederick Health Medical Group LLC

Doing business as Frederick Health Medical Group

  • Urology Physician
  • Frederick, MD
National Provider Identifier
1578831145
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
FREDERICK HEALTH MEDICAL GROUP LLC
Doing business as
Frederick Health Medical Group
Frederick Urology Specialists
Practice address
1562 Opossumtown Pike Ste 301
Frederick, MD 21702-4337
Phone
(301) 663-4774
Fax
(301) 695-1364
NPI assigned
Dec 9, 2011
Last updated
Jan 24, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FREDERICK HEALTH MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Authorized official

Name
Michelle K Mahan
Title
Sr. VP and Cfo
Phone
(240) 566-3355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

1562 Opossumtown Pike Ste 301
Frederick, MD 21702-4337

Mailing address

900 Toll House Ave
Frederick, MD 21701-4547
Phone (301) 663-4774

Other names 3

  • Frederick Health Medical Group Doing business as
  • Frederick Urology Specialists Doing business as
  • Monocacy Health Partners LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130820000555 MD Part B Supplier - Clinic/Group Practice 9931341096 Receives reassigned benefits from 296 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Ijamsville, MD; Mount Airy, MD; Myersville, MD; Walkersville, MD; Adamstown, MD; Brunswick, MD; Emmitsburg, MD

Other NPIs on the same Medicare enrollment 40

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

View all 40

National Provider Directory

National Provider Directory
Part of
Frederick Health Med GRP

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579824000000",
    "number": "1578831145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 TOLL HOUSE AVE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217014547",
            "telephone_number": "301-663-4774",
            "fax_number": "301-695-1364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1562 OPOSSUMTOWN PIKE STE 301",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024337",
            "telephone_number": "301-663-4774",
            "fax_number": "301-695-1364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK HEALTH MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDERICK HEALTH MEDICAL GROUP LLC",
        "enumeration_date": "2011-12-09",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SR. VP AND CFO",
        "authorized_official_telephone_number": "240-566-3355"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frederick Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Frederick Urology Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monocacy Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in 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, 2020; 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.