Individual provider Active NPI

Maxine Lugay Cruz-Am, FNP-C

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1629731286
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R223063 Issued in MD
Practice address
630 S Exeter St
Baltimore, MD 21202-4316
Phone
(410) 962-6520
NPI assigned
Oct 20, 2021
Last updated
Oct 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R223063 MD Primary

Addresses

Primary practice location

630 S Exeter St
Baltimore, MD 21202-4316

Mailing address

510 Dogwood Rd
Linthicum Heights, MD 21090-2326
Phone (443) 867-7389

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220308000089 DC Practitioner - Nurse Practitioner 2961896964 Reassigns benefits to 1 organization
I20240814003917 MD Practitioner - Nurse Practitioner 2961896964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidalhealth Specialty Care LLCGroup PAC ID 7113340845, 375 clinicians

Practice addresses (Care Compare)

100 E Carroll St
Salisbury, MD 21801-5422

400 Eastern Shore Dr
Salisbury, MD 21804-5513

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Physician Services, Inc. CurrentSince Feb 1, 2022 Accepting new patients
Tidalhealth Specialty Care, LLC CurrentSince Aug 26, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Tidalhealth Specialty Care, LLC Past Accepting new patients

Locations

820 W Diamond Ave
Gaithersburg, MD 20878
Phone (301) 315-3030

820 W Diamond Ave
Ste 500
Gaithersburg, MD 20878

15225 Shady Grove Rd
Ste 201
Rockville, MD 20850
Phone (301) 670-3000

9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1629731286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 DOGWOOD RD",
            "city": "LINTHICUM HEIGHTS",
            "state": "MD",
            "postal_code": "210902326",
            "telephone_number": "443-867-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 S EXETER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024316",
            "telephone_number": "410-962-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ-AM",
        "first_name": "MAXINE",
        "middle_name": "LUGAY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R223063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.