NPIMap

Organization Active NPI

Meritus Medical Laboratory LLC

  • Clinical Medical Laboratory
  • Hagerstown, MD
National Provider Identifier
1679518971
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
134 Issued in MD
Legal business name
MERITUS MEDICAL LABORATORY LLC
Practice address
11110 Medical Campus Rd
Suite 230
Hagerstown, MD 21742-6700
Phone
(301) 665-4900
Fax
(301) 665-4949
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Authorized official

Name
Joshua Repac
Title
Cfo
Phone
(301) 790-9351

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 134 MD Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 230
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Rd
Suite 230
Hagerstown, MD 21742-6700
Phone (301) 665-4900

Other identifiers 3

IdentifierTypeStateIssuer
5580431MedicaidWV
214847OtherMDIPA/MAMSI/UHC
411588104MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110930000142 MD Part B Supplier - Independent Clinical Laboratory 2567634264 Practice locations: Hagerstown, MD

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0220737Meritus Womens Health Specialists at Robinwood11110 Medical Campus Road Ste 107, Hagerstown, MD 21742Provider-performed microscopyJan 24, 2028
21D0220805Meritus Medical Laboratory, LLC11110 Medical Campus Rd Suite 230, Hagerstown, MD 21742AccreditationJul 26, 2027
21D0220849Meritus Urology11110 Medical Campus Rd Ste #228, Hagerstown, MD 21742Certificate of waiverMar 7, 2027
21D0875997Meritus Family Medicine Suite 20011110 Medical Campus Road #200, Hagerstown, MD 21742Provider-performed microscopySep 6, 2027
21D0923944Meritus Internal Medicine Robinwood St 15011110 Medical Campus Road Suite 150, Hagerstown, MD 21742Certificate of waiverFeb 22, 2028
21D0984445Meritus Digestive Health Specialists11110 Medical Campus Rd Ste 246, Hagerstown, MD 21742Certificate of waiverMar 21, 2027
21D1003826Bio-Medical Appl of MD Inc Dba FMC of Robinwood11110 Medical Campus Rd Ste 149, Hagerstown, MD 21742Certificate of waiverSep 11, 2026
21D2029575Meritus Pain Specialist11110 Medical Campus Road Ste 225, Hagerstown, MD 21742Certificate of waiverSep 11, 2027
21D2281566Medical Practices of Antietam LLC Dba11110 Medical Campusrd Suite 229, Hagerstown, MD 21742AccreditationJul 17, 2027
21D2306106Medical Practices of Antietam- Mobile Health11110 Medical Campus Rd, Hagerstown, MD 21742Certificate of waiverJun 10, 2028
21D2336585Meritus Fast Lane Care11110 Medical Campus Rd Suite 147, Hagerstown, MD 21742Certificate of waiverJan 6, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

353 N Pennsylvania Ave
Hancock, MD 21750

Practitioners & affiliated clinicians

Practitioners 122

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

View all 122

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666742400000",
    "number": "1679518971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 230",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-665-4900",
            "fax_number": "301-665-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 230",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-665-4900",
            "fax_number": "301-665-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERITUS MEDICAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "REPAC",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-790-9351"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5580431",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA/MAMSI/UHC",
            "identifier": "214847",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "411588104",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; 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.