NPIMap

Organization Active NPI

University of Maryland Sports Medicine and Wellness, LLC

  • Sports Medicine (Family Medicine) Physician
  • College Park, MD
National Provider Identifier
1710375910
Registry record updated Dec 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
UNIVERSITY OF MARYLAND SPORTS MEDICINE AND WELLNESS, LLC
Practice address
379 Field House Dr
College Park, MD 20742-5415
Phone
(667) 214-1333
NPI assigned
Dec 23, 2014
Last updated
Dec 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2014

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

Authorized official

Name
Ms. Melanie Robin
Title
Incentive Programs Manager
Phone
(667) 214-1069

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

379 Field House Dr
College Park, MD 20742-5415

Mailing address

PO Box 64380
Baltimore, MD 21264-4380

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180314002555 MD Part B Supplier - Clinic/Group Practice 5395007124 Receives reassigned benefits from 4 practitioners
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory
Tax ID family
University of Maryland Sports Medicine and Wellness LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

379 Fieldhouse Dr
College Park, MD 20742
Phone (240) 417-1511

379 Fld House Dr
College Park, MD 20742
Phone (240) 508-3530

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419292800000",
    "number": "1710375910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64380",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 FIELD HOUSE DR",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207425415",
            "telephone_number": "667-214-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MARYLAND SPORTS MEDICINE AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-23",
        "last_updated": "2014-12-23",
        "status": "A",
        "authorized_official_last_name": "ROBIN",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "INCENTIVE PROGRAMS MANAGER",
        "authorized_official_telephone_number": "667-214-1069",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; 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.