Individual provider Active NPI

Michael J. Guerriere, PA-C

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1639640410
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
CX07058 Issued in MD
Practice address
2401 W Belvedere Ave
Baltimore, MD 21215-5216
Phone
(607) 267-8937
NPI assigned
Dec 5, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X CX07058 MD Primary

Addresses

Primary practice location

2401 W Belvedere Ave
Baltimore, MD 21215-5216

Mailing address

16 E Bishops Rd
Baltimore, MD 21218-2312
Phone (607) 267-8937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 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
I20181231000766 MD Practitioner - Physician Assistant 8820333487 Reassigns benefits to 6 organizations
I20210319000633 DC Practitioner - Physician Assistant 8820333487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifebridge Orthopedic Specialists LLCGroup PAC ID 4082928098, 46 clinicians

Practice addresses (Care Compare)

2401 E Belvedere Ave
Baltimore, MD 21215-5216

5415 Old Court Rd
Randallstown, MD 21133-5170
Phone (410) 701-4437

Hospital & facility affiliations

  • Sinai Hospital of Baltimore Hospital, Baltimore, MD, CCN 210012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
CX07058MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Statcare Group, LLC CurrentSince Mar 3, 2019 Accepting new patients
Medstar Urgent Care LLC CurrentSince Apr 11, 2021 Accepting new patients
Medstar Urgent Care LLC CurrentSince Apr 11, 2021 Accepting new patients
Umms Ambulatory Care LLC CurrentSince Jan 1, 2021 Accepting new patients

Locations

6317 York Rd
Baltimore, MD 21212
Phone (443) 777-6890

8 Denton Plz
#1
Denton, MD 21629
Phone (443) 606-2300

8 Denton Plz
Denton, MD 21629
Phone (443) 606-2300

1730 Merritt Blvd
Dundalk, MD 21222
Phone (410) 282-2756

2315 Bel Air Rd
Ste C1
Fallston, MD 21047
Phone (443) 966-3900

1220A E Joppa Rd
Ste 109
Towson, MD 21286
Phone (410) 296-0018

3064 Waldorf Market Pl
Waldorf, MD 20603
Phone (301) 932-5960

11915 Georgia Ave
Wheaton, MD 20902
Phone (301) 942-4505

2000 15th St N
Ste 600
Arlington, VA 22201
Phone (202) 425-0000

Organizations & group practices 11

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

Hospital & facility affiliations 2

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": "1543968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1639640410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 E BISHOPS RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212182312",
            "telephone_number": "607-267-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W BELVEDERE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155216",
            "telephone_number": "607-267-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUERRIERE",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-05",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "CX07058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.