Active NPI
Raj Manickam, MD
- Pediatrics Physician
- Crownsville, MD
National Provider Identifier
1649200965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0018398
- Practice address
- 1350 Sweet Pea Path
Crownsville, MD 21032-2020 - Phone
- (410) 987-7375
- NPI assigned
- Jul 3, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0018398 | MD | Primary |
Addresses
Primary practice location
1350 Sweet Pea Path
Crownsville, MD 21032-2020
Mailing address
1350 Sweet Pea Path
Crownsville, MD 21032-2020
Phone (410) 987-7375
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 960281000 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050329000092 | MD | Practitioner - Pediatric Medicine | 6709832215 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Other, 1970
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Urgent Care Medicine, LLC
Practice addresses (Care Compare)
3059 Solomons Island Rd
F 2
Edgewater, MD 21037-1433
Phone (410) 956-3394
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Provider Management, LLC | Current | Accepting new patients | |
| Urgent Care Medicine, LLC | Current | Accepting new patients | |
| Dimensions Health Corporation | Past | Accepting new patients | |
| Harcart Health Holdings, LLC | Past | Accepting new patients | |
| Baltimore Washington Emergency Physicians, Inc. | Past | Accepting new patients |
Locations
3059 Solomons Island Rd
#F2
Edgewater, MD 21037
Phone (410) 956-3394
177 Saint Patricks Dr
Ste 101
Waldorf, MD 20603
Phone (240) 303-2901
Organizations & group practices 5
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1649200965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 SWEET PEA PATH",
"city": "CROWNSVILLE",
"state": "MD",
"postal_code": "210322020",
"telephone_number": "410-987-7375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 SWEET PEA PATH",
"city": "CROWNSVILLE",
"state": "MD",
"postal_code": "210322020",
"telephone_number": "410-987-7375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANICKAM",
"first_name": "RAJ",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0018398",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "960281000",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crownsville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.