Individual provider Active NPI

Andrew Jay Cardin, M.D.

  • Pediatrics Physician
  • Owings Mills, MD
National Provider Identifier
1700992567
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0045631 Issued in MD
Practice address
10085 Red Run Blvd
Suite 103
Owings Mills, MD 21117-4836
Phone
(410) 363-2240
Fax
(410) 363-3858
NPI assigned
Aug 22, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0045631 MD Primary

Addresses

Primary practice location

10085 Red Run Blvd
Suite 103
Owings Mills, MD 21117-4836

Mailing address

10085 Red Run Blvd
Suite 103
Owings Mills, MD 21117-4836
Phone (410) 363-2240

Other identifiers 1

IdentifierTypeStateIssuer
9137114000MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151012001367 MD Practitioner - Pediatric Medicine 0840509964 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0045631MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Pediatrics CurrentSince Sep 27, 2015 Accepting new patients
Privia Medical Group, LLC CurrentSince Sep 27, 2015 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

133 Defense Hwy
Ste 112
Annapolis, MD 21401
Phone (410) 573-0140

10085 Red Run Blvd
Ste 103
Owings Mills, MD 21117
Phone (410) 363-2240

11350 Pembrooke Sq
Ste 304
Waldorf, MD 20603
Phone (301) 856-2810

Interoperability endpoints

  • Direct secure messaging: andrew.cardin.1@8042.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700992567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10085 RED RUN BLVD",
            "address_2": "SUITE 103",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174836",
            "telephone_number": "410-363-2240",
            "fax_number": "410-363-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10085 RED RUN BLVD",
            "address_2": "SUITE 103",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174836",
            "telephone_number": "410-363-2240",
            "fax_number": "410-363-3858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDIN",
        "first_name": "ANDREW",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0045631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9137114000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

Verify at the official NPI Registry.