NPIMap

Organization Active NPI

Civista Clinical Services, LLC

  • Endoscopy Clinic/Center
  • La Plata, MD
National Provider Identifier
1689212151
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endoscopy Clinic/CenterTaxonomy code 261QE0800X
Legal business name
CIVISTA CLINICAL SERVICES, LLC
Practice address
5 N la Plata CT Ste 201
La Plata, MD 20646-5208
Phone
(301) 609-4000
NPI assigned
Dec 16, 2019
Organization subpart
Yes
Parent organization
CIVISTA CLINICAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Authorized official

Name
Albert Zanger
Title
Chief Financial Officer
Phone
(301) 609-5163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endoscopy Clinic/Center 261QE0800X Primary

Addresses

Primary practice location

5 N la Plata CT Ste 201
La Plata, MD 20646-5208

Mailing address

5 N la Plata CT Ste 201
La Plata, MD 20646-5208
Phone (301) 609-5080

Other names 1

  • UM Charles Regional Endoscopy Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201231001354 MD Part B Supplier - Ambulatory Surgical Center 1951490994 Practice locations: La Plata, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Civista Clinical Services Dba Um Charles Regional Endoscopy CenterCCN 21C0001638
Medicare certification status
ActiveFrom the Provider of Services file

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
21D2230266Civista Clinical Services LLC Dba Umcrmg Endoscopy5 N la Plata Court Suite 201, La Plata, MD 20646Certificate of waiverJul 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Civista Clinical SRVC LLC4 organizations share this tax ID, including this one
Part of
Civista Clinical SRVC LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5 N La Plata Ct
La Plata, MD 20646
Phone (240) 307-4700

NPI Registry JSON

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1689212151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 N LA PLATA CT STE 201",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465208",
            "telephone_number": "301-609-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 N LA PLATA CT STE 201",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465208",
            "telephone_number": "301-609-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA CLINICAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIVISTA CLINICAL SERVICES, LLC",
        "enumeration_date": "2019-12-16",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "ZANGER",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-609-5163"
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UM Charles Regional Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UM Charles Regional Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; 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.