NPIMap

Organization Active NPI

Luminis Health Medical Group, LLC

Doing business as South River Family Medicine

  • Family Medicine Physician
  • Edgewater, MD
National Provider Identifier
1699742874
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LUMINIS HEALTH MEDICAL GROUP, LLC
Doing business as
South River Family Medicine
Practice address
3169 Braverton St
Suite 201
Edgewater, MD 21037-2679
Phone
(410) 956-4911
Fax
(410) 956-4935
NPI assigned
Mar 7, 2006
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ANNE ARUNDEL PHYSICIAN GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Melissa Rapattoni
Title
Ao
Phone
(443) 481-5136

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3169 Braverton St
Suite 201
Edgewater, MD 21037-2679

Mailing address

2000 Medical Pkwy Ste 409
Annapolis, MD 21401-3746
Phone (443) 481-5136

Other identifiers 3

IdentifierTypeStateIssuer
955BSOOtherBCBS
K643OtherBCBS
407175107MedicaidMD

Other names 1

  • SOUTH RIVER FAMILY MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050317000146 MD Part B Supplier - Clinic/Group Practice 2860447315 Receives reassigned benefits from 897 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Luminis Health Primary Care224 organizations share this tax ID, including this one
Part of
Luminis Health Primary Care

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1699742874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MEDICAL PKWY STE 409",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013746",
            "telephone_number": "443-481-5136",
            "fax_number": "443-481-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3169 BRAVERTON ST",
            "address_2": "SUITE 201",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372679",
            "telephone_number": "410-956-4911",
            "fax_number": "410-956-4935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINIS HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNE ARUNDEL PHYSICIAN GROUP LLC",
        "enumeration_date": "2006-03-07",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "RAPATTONI",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "443-481-5136"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "955BSO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "K643",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407175107",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH RIVER FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTH RIVER FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewater, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.