NPIMap

Organization Active NPI

Civista Clinical Services, LLC

  • Surgery Physician
  • La Plata, MD
National Provider Identifier
1710247440
Registry record updated Jun 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CIVISTA CLINICAL SERVICES, LLC
Practice address
500 Charles St
La Plata, MD 20646-5931
Phone
(301) 609-4539
NPI assigned
May 29, 2012
Organization subpart
Yes
Parent organization
CIVISTA CLINICAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2014

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

Authorized official

Name
Stephanie Simm
Title
Physician Relations Specialist
Phone
(301) 609-4539

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

500 Charles St
La Plata, MD 20646-5931

Mailing address

75 Remittance Dr Dept 6554
Chicago, IL 60675-6554
Phone (301) 609-4539

Other names 1

  • La Plata Surgical Care Doing business as

National Provider Directory

National Provider Directory
Part of
Civista Clinical SRVC LLC

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1710247440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 REMITTANCE DR DEPT 6554",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606756554",
            "telephone_number": "301-609-4539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CHARLES ST",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465931",
            "telephone_number": "301-609-4539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA CLINICAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIVISTA CLINICAL SERVICES, LLC",
        "enumeration_date": "2012-05-29",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "SIMM",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PHYSICIAN RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "301-609-4539"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Plata Surgical Care",
            "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 Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.