PG County Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PG COUNTY ENDOSCOPY CENTER LLC

Practice address

6502 Kenilworth Ave Ste 200
Riverdale, MD 20737-1371

Phone

(410) 290-6677

Fax

(410) 290-6676

NPI assigned

May 3, 2022

Organization subpart

No

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

Authorized official

Name

Zachary D Jones

Title

Ceo

Phone

(207) 631-7837

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Listed as

PG County Endoscopy Center LLCCCN 21C0001662

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765497600000",
    "number": "1629713730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7120 MINSTREL WAY STE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210455274",
            "telephone_number": "410-290-6677",
            "fax_number": "410-290-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 KENILWORTH AVE STE 200",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371371",
            "telephone_number": "410-290-6677",
            "fax_number": "410-290-6676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6502 Kenilworth Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "MD",
            "postal_code": "207371372",
            "country_code": "US",
            "telephone_number": "410-290-6677",
            "fax_number": "410-290-6676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PG COUNTY ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-03",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-631-7837"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Kilsoon Park, DDS
• Patient Care Jobfinders
• Julene Tina Pena, O.D., F.A.A.O.
• Sammir Perez Sanjuanelo, MD
• Gail Ann Petersen, O.D.
• Mariana Polanco Alvarez
• Jeri Price
• Professional Home Care of Maryland Inc
• Melissa Prosper
• Providence Care Inc

• Ambulatory Surgical Clinic/Center in Riverdale, MD
• Providers in Riverdale, MD by specialty
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.