Active NPI
Civista Clinical Sercives, LLC
- Neurology Physician
- La Plata, MD
National Provider Identifier
1619237344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- CIVISTA CLINICAL SERCIVES, LLC
- Practice address
- 101 Centennial St
Suite B
La Plata, MD 20646-5975 - Phone
- (301) 609-4539
- NPI assigned
- May 29, 2012
- Last updated
- Jun 12, 2014
- Organization subpart
- Yes
- Parent organization
- UNIVERSITY OF MARYLAND CHARLES REGIONAL MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephanie Simm
- Title
- Physician Relations Specialist
- Phone
- (301) 609-4539
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | Primary |
Addresses
Primary practice location
101 Centennial St
Suite B
La Plata, MD 20646-5975
Mailing address
75 Remittance Dr Dept 6554
Chicago, IL 60675-6554
Phone (301) 609-4539
Other names 1
- University of Maryland Charles Regional Neurology Center
National Provider Directory
National Provider Directory- Part of
- Civista Clinical SVC LLC
Locations
75 Remittance Dr
Dept 6554
Chicago, IL 60675
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Audiologist-Hearing Aid Fitter
- La Plata, MD
- NPI 1285976266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338249600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1402531200000",
"number": "1619237344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 REMITTANCE DR DEPT 6554",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606756554",
"telephone_number": "301-609-4539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CENTENNIAL ST",
"address_2": "SUITE B",
"city": "LA PLATA",
"state": "MD",
"postal_code": "206465975",
"telephone_number": "301-609-4539"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CIVISTA CLINICAL SERCIVES, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "UNIVERSITY OF MARYLAND CHARLES REGIONAL MEDICAL GROUP",
"enumeration_date": "2012-05-29",
"last_updated": "2014-06-12",
"status": "A",
"authorized_official_last_name": "SIMM",
"authorized_official_first_name": "STEPHANIE",
"authorized_official_title_or_position": "PHYSICIAN RELATIONS SPECIALIST",
"authorized_official_telephone_number": "301-609-4539"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "University of Maryland Charles Regional Neurology Center",
"code": "5",
"type": "Other Name"
}
]
}Other providers in La Plata, MD
- Ryan Elise Cheatham-Jackson, PHARM D
- Yufei Chen, STUDENT
- Lisa Chernoff, LCPC
- Patrick S Cieplak, DDS
- Citizens Run Inc
- Civista Clinical Services, L.L.C.
- Civista Clinical Services, LLC (University of Maryland Charles Regional OB/GYN)
- Civista Clinical Services, LLC
- Civista Clinical Services, LLC (UM Charles Regional Endoscopy Center)
- Civista Clinical Services, LLC (La Plata Surgical Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.