Southside Pediatrics & Adult Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

193525 Issued in MD

Legal business name

SOUTHSIDE PEDIATRICS & ADULT CARE LLC

Practice address

1185 Mount Aetna Rd Ste 200
Hagerstown, MD 21740-6832

Phone

(240) 513-6300

NPI assigned

Jan 31, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Christa Martin, CRNPNPI 1053302455

Title

Owner

Phone

(240) 513-6300

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Christa L Martin DBA South Side Pediatrics Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christa Lea Martin, CRNP

  • Pediatric Nurse Practitioner
  • Hagerstown, MD
  • NPI 1053302455
  NPD (past) Authorized official

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1669970067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 MOUNT AETNA RD STE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406832",
            "telephone_number": "240-513-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 MOUNT AETNA RD STE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406832",
            "telephone_number": "240-513-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PEDIATRICS & ADULT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-31",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-513-6300",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "193525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1053302455",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christa L Martin DBA South Side Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Primary Care Clinic/Center in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.