Nino Dgebuadze, M.D., PH.D.
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Hagerstown, MD
NPI 1679779409 · NPPES record last updated Nov 20, 2018
Key facts
- NPI
- 1679779409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- D0073349 (MD)
- Practice address
- 17 Western Maryland Pkwy
Suite 100
Hagerstown, MD 21740 - Phone
- (301) 797-9240
- Fax
- (301) 797-4119
- NPI assigned
- Jun 27, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
-
Inder Chawla, M.D.
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Physical Medicine and Rehabilitation
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Adventist Physician Services Inc
Practice addresses (Care Compare)
11886 Healing Way
Silver Spring, MD 20904-7917
11890 Healing Way
Suite 6S
Silver Spring, MD 20904-7917
Phone (240) 637-4000
9901 Medical Ctr Dr
Rockville, MD 20850-3357
Phone (301) 279-6000
Hospital & facility affiliations
- Adventist Healthcare Shady Grove Medical Center
- Suburban Hospital
- Adventist Healthcare White Oak Medical Center
- Medstar Montgomery Medical Center
- Holy Cross Hospital
- Adventist Healthcare Rehabilitation at Rockville
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130625000073 | DC | Practitioner - Physical Medicine and Rehabilitation | 1850559261 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007012244 | MO | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adventist Physician Services, Inc. | Physical Medicine & Rehabilitation | Current |
Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Adventist Physician Services (Wah) | Past | Accepting new patients | |
| Adventist Rehabilitation Hospital of Maryland Inc | Past | Accepting new patients |
Locations
820 W Diamond Ave
Ste 500
Gaithersburg, MD 20878
820 W Diamond Ave
Gaithersburg, MD 20878
Phone (301) 315-3030
9909 Medical Center Dr
Rockville, MD 20850
Phone (240) 864-6000
9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000
11886 Healing Way
Silver Spring, MD 20904
Phone (301) 608-3833
11890 Healing Way
Silver Spring, MD 20904
Phone (240) 637-4000
11886 Healing Way
#306
Silver Spring, MD 20904
Interoperability endpoints
- nino.dgebuadze@ahm.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | D0073349 | MD | Yes |
| Physical Medicine & Rehabilitation Physician | 208100000X | 2007012244 | MO |
Addresses
Primary practice location
17 Western Maryland Pkwy
Suite 100
Hagerstown, MD 21740
Mailing address
4444 Forest Park Ave
Campus Box 8518
Saint Louis, MO 63108-8518
Phone (314) 454-7757
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 97628601 | Other | MD | BCBS LOCAL CAREFIRST KG85 |
| 333505400 | Medicaid | MD | |
| W2660030 | Other | MD | BCBS REGIONAL W266 |
| P01024230 | Other | MD | RR MEDICARE MD |
Other providers in Hagerstown, MD
- Devoted Wellness and Counseling Services LLC
- Devoted Wellness and Counseling Services LLC
- Devoted Wellness and Counseling Services LLC
- Devoted Wellness and Counseling Services LLC
- Nick J Dewaal
- Diagnostic Imaging Services, LLC
- Diakon Child, Family & Community
- Diakon Lutheran Senior Living - Maryland LLC
- Diakon Lutheran Senior Living - Maryland LLC
- Diakon Lutheran Senior Living-Maryland Ravenwood Campus
All providers in Hagerstown, MD · Physical Medicine & Rehabilitation Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.