Active NPI
Michael Groden
- General Practice Physician
- JB Andrews, MD
National Provider Identifier
1598350522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0101275925
- Practice address
- 1060 W Perimeter Rd
JB Andrews, MD 20762-6602 - Phone
- (888) 999-1212
- NPI assigned
- Mar 2, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0101275925 | VA | Primary |
Addresses
Primary practice location
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Mailing address
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Phone (888) 999-1212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101275925 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713398400000",
"number": "1598350522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "888-999-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "888-999-1212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRODEN",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-02",
"last_updated": "2024-04-18",
"certification_date": "2024-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0101275925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in JB Andrews, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.