South River Internal Medicine, PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D58166 Issued in MD

Legal business name

SOUTH RIVER INTERNAL MEDICINE, PA

Practice address

3168 Braverton St Ste 250
Edgewater, MD 21037-2682

Phone

(410) 956-1600

Fax

(410) 956-7900

NPI assigned

Nov 13, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Renee Lynn Nye

Title

Ama/Front Office Manager

Phone

(410) 956-1600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Eric Charles Marcalus, MD

  • Internal Medicine Physician
  • Edgewater, MD
  • NPI 1336190248
  Medicare reassignment NPD

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

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725235200000",
    "number": "1710131024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3168 BRAVERTON ST",
            "address_2": "SUITE 250",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372674",
            "telephone_number": "410-956-1600",
            "fax_number": "410-956-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3168 BRAVERTON ST STE 250",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372682",
            "telephone_number": "410-956-1600",
            "fax_number": "410-956-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH RIVER INTERNAL MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-13",
        "last_updated": "2024-09-02",
        "certification_date": "2024-09-02",
        "status": "A",
        "authorized_official_last_name": "NYE",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "AMA/FRONT OFFICE MANAGER",
        "authorized_official_telephone_number": "410-956-1600",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D58166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "514113300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claire Skelton
• Catherine Smith-Heine, LCPC, NCC
• Sol & Luna Wellness LLC
• South River Ambulatory Surgery
• South River Family Chiropractic LLC
• South River Nursing and Rehab Center LLC (South River Rehabilitation and Wellness Center)
• South River Primary Care LLC
• Alexa Spearman
• Jessica Lynne Stallings, CRNP-PMH, PMHNP-BC
• Statcare Group LLC (Patriot Urgent Care)

• Internal Medicine Physician in Edgewater, MD
• Providers in Edgewater, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2024; 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.