NPIMap

Organization Active NPI

Medical Practices of Antietam LLC

  • Clinic/Center
  • Hagerstown, MD
National Provider Identifier
1710854963
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MEDICAL PRACTICES OF ANTIETAM LLC
Practice address
11110 Medical Campus Rd
Hagerstown, MD 21742-6700
Phone
(301) 790-8000
NPI assigned
Oct 22, 2025
Last updated
Oct 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Authorized official

Name
Joshua Repac
Title
Cfo
Phone
(301) 790-9351

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324001019 MD Part B Supplier - Clinic/Group Practice 2567353865 Receives reassigned benefits from 283 practitioners
2 other NPIs on this enrollment
Practice locations: Hagerstown, MD; Hancock, MD; Smithsburg, MD; Williamsport, MD; Cascade, MD; Frederick, MD

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Medical Practices of Antietam LLC63 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11110 Medical Campus Rd
#150N
Hagerstown, MD 21742
Phone (240) 313-9850

11110 Medical Campus Rd
Ste 242
Hagerstown, MD 21742
Phone (240) 291-2366

11236 Robinwood Dr
Ste 101
Hagerstown, MD 21742
Phone (240) 313-4242

1130 Professional Ct
Hagerstown, MD 21740
Phone (301) 791-5555

13424 Pennsylvania Ave
#203N
Hagerstown, MD 21742
Phone (240) 313-9850

17301 Valley Mall Rd
#125
Hagerstown, MD 21740
Phone (301) 790-9237

1799 Howell Rd
Ste 101
Hagerstown, MD 21740
Phone (301) 790-9220

186 Eastern Blvd N
Hagerstown, MD 21740
Phone (301) 302-7837

24 N Walnut St
Ste 100
Hagerstown, MD 21740
Phone (240) 452-3400

322 E Antietam St
Ste 101
Hagerstown, MD 21740
Phone (301) 733-2431

356 Mill St
Hagerstown, MD 21740
Phone (301) 393-3838

16505 Virginia Ave
Williamsport, MD 21795
Phone (301) 582-1628

1823 E Main St
#A
Waynesboro, PA 17268
Phone (717) 762-3353

Practitioners & affiliated clinicians

Practitioners 284

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.

View all 284

NPI Registry JSON

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

{
    "created_epoch": "1761091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1710854963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-790-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PRACTICES OF ANTIETAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-22",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "REPAC",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-790-9351"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.