NPIMap

Organization Active NPI

Family Medicine Shady Grove

  • Family Medicine Physician
  • Rockville, MD
National Provider Identifier
1588093371
Registry record updated Apr 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0073851 Issued in MD
Legal business name
FAMILY MEDICINE SHADY GROVE
Practice address
15215 Shady Grove Rd Ste 304
Rockville, MD 20850-0200
Phone
(301) 284-8990
Fax
(301) 569-4293
NPI assigned
Nov 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2014

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

Authorized official

Name
Dr. Manisha Kalra, M.D.NPI 1942255468
Title
Physician
Phone
(301) 284-8990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X D0073851 MD Primary

Addresses

Primary practice location

15215 Shady Grove Rd Ste 304
Rockville, MD 20850-0200

Mailing address

15215 Shady Grove Rd Ste 304
Rockville, MD 20850-0200
Phone (301) 284-8990

Other names 1

  • Family Medicine Shady Grove, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140501001029 DC Part B Supplier - Clinic/Group Practice 3375775612 Receives reassigned benefits from 2 practitioners
Practice locations: Rockville, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1588093371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15215 SHADY GROVE RD STE 304",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208500200",
            "telephone_number": "301-284-8990",
            "fax_number": "301-569-4293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15215 SHADY GROVE RD STE 304",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208500200",
            "telephone_number": "301-284-8990",
            "fax_number": "301-569-4293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE SHADY GROVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "KALRA",
        "authorized_official_first_name": "MANISHA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "301-284-8990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0073851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Shady Grove, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; 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.