NPIMap

Organization Active NPI

Lower Shore Immediate Care LLC

  • Urgent Care Clinic/Center
  • Princess Anne, MD
National Provider Identifier
1679927982
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
LOWER SHORE IMMEDIATE CARE LLC
Practice address
12302 Somerset Ave
Suite a/B
Princess Anne, MD 21853-3099
Phone
(410) 651-0300
Fax
(302) 947-4433
NPI assigned
Apr 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

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

Authorized official

Name
Kim Frock
Title
Contracting and Credentialing
Phone
(605) 789-6661

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Urgent Care Clinic/Center 261QU0200X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X

Addresses

Primary practice location

12302 Somerset Ave
Suite a/B
Princess Anne, MD 21853-3099

Mailing address

12302 Somerset Ave
Suite a/B
Princess Anne, MD 21853-3099
Phone (410) 651-0300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161020002345 MD Part B Supplier - Clinic/Group Practice 0749578300 Receives reassigned benefits from 8 practitioners
Practice locations: Princess Anne, 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
21D2120583Lower Shore Immediate Care12302 Somerset Ave Suite a/B, Princess Anne, MD 21853Certificate of waiverOct 18, 2026

National Provider Directory

National Provider Directory

Locations

12302 Somerset Ave
Princess Anne, MD 21853
Phone (410) 651-0300

12302 Somerset Ave
Ste Ab
Princess Anne, MD 21853
Phone (410) 651-0300

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1679927982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12302 SOMERSET AVE",
            "address_2": "SUITE A/B",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218533099",
            "telephone_number": "410-651-0300",
            "fax_number": "302-947-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12302 SOMERSET AVE",
            "address_2": "SUITE A/B",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218533099",
            "telephone_number": "410-651-0300",
            "fax_number": "302-947-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWER SHORE IMMEDIATE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-22",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "FROCK",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CONTRACTING AND CREDENTIALING",
        "authorized_official_telephone_number": "605-789-6661"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princess Anne, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.