NPIMap

Individual provider Active NPI

Nino Dgebuadze, M.D., PH.D.

  • Physical Medicine & Rehabilitation Physician
  • Hagerstown, MD
National Provider Identifier
1679779409
Registry record updated Nov 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
D0073349 Issued in 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
Last updated
Nov 20, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X D0073349 MD Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130625000073 DC Practitioner - Physical Medicine and Rehabilitation 1850559261 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Physician Services IncGroup PAC ID 4284631540, 144 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2007012244MOMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Physician Services, Inc. Physical Medicine & Rehabilitation CurrentSince Nov 1, 2019 Accepting new patients
Adventist Rehabilitation Hospital of Maryland Inc Past Accepting new patients
Adventist Physician Services (Wah) Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

820 W Diamond Ave
Gaithersburg, MD 20878
Phone (301) 315-3030

820 W Diamond Ave
Ste 500
Gaithersburg, MD 20878

9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000

9909 Medical Center Dr
Rockville, MD 20850
Phone (240) 864-6000

11886 Healing Way
Silver Spring, MD 20904
Phone (301) 608-3833

11886 Healing Way
#306
Silver Spring, MD 20904

11890 Healing Way
Silver Spring, MD 20904
Phone (240) 637-4000

Interoperability endpoints

  • Direct secure messaging: nino.dgebuadze@ahm.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542672000000",
    "number": "1679779409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 FOREST PARK AVE",
            "address_2": "CAMPUS BOX 8518",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631088518",
            "telephone_number": "314-454-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WESTERN MARYLAND PKWY",
            "address_2": "SUITE 100",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "21740",
            "telephone_number": "301-797-9240",
            "fax_number": "301-797-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DGEBUADZE",
        "first_name": "NINO",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2018-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "D0073349",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2007012244",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.