Organization Active NPI

Newbridge Surgery Center at Waldorf

  • Ambulatory Surgical Clinic/Center
  • Waldorf, MD
National Provider Identifier
1710112669
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NEWBRIDGE SURGERY CENTER AT WALDORF
Practice address
3581 Old Washington Road
Suite G
Waldorf, MD 20602
Phone
(301) 638-4400
Fax
(301) 638-2200
NPI assigned
May 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Mruthyunjaya Gonchigar, M.D.NPI 1043275449
Title
Owner/Physician
Phone
(301) 668-9988

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3581 Old Washington Road
Suite G
Waldorf, MD 20602

Mailing address

196 Thomas Johnson Dr
Suite 215
Frederick, MD 21702-4397
Phone (301) 668-9988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121015000065 MD Part B Supplier - Ambulatory Surgical Center 3870628431 Receives reassigned benefits from 1 practitioner
Practice locations: Waldorf, MD
O20230412002140 MD Part B Supplier - Clinic/Group Practice 9133416191 Receives reassigned benefits from 1 practitioner
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfax, VA; Frederick, MD; Potomac, MD; Prince Frederick, MD; Waldorf, MD

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Newbridge Surgery Center at WaldorfCCN 21C0001540
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
21D2048581Newbridge Surgery Center at Waldorf, LLC3581 Old Washington Road, Ste G, Waldorf, MD 20602Certificate of waiverOct 17, 2026

National Provider Directory

National Provider Directory

Locations

3581 Old Washington Rd
Ste G
Waldorf, MD 20602
Phone (301) 638-4400

Practitioners & affiliated clinicians

Practitioners 3

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": "1242864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1710112669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR",
            "address_2": "SUITE 215",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024397",
            "telephone_number": "301-668-9988",
            "fax_number": "301-668-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3581 OLD WASHINGTON ROAD",
            "address_2": "SUITE G",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "20602",
            "telephone_number": "301-638-4400",
            "fax_number": "301-638-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWBRIDGE SURGERY CENTER AT WALDORF",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-21",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "GONCHIGAR",
        "authorized_official_first_name": "MRUTHYUNJAYA",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "301-668-9988",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; 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.