NPIMap

Organization Active NPI

St. Agnes Healthcare, Inc.

Doing business as George Thomas Grace M.D. Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Baltimore, MD
National Provider Identifier
1720227176
Registry record updated Feb 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1300 Issued in MD
Legal business name
ST. AGNES HEALTHCARE, INC.
Doing business as
George Thomas Grace M.D. Surgery Center
Practice address
300 Frederick Rd
Suite 200
Baltimore, MD 21228-4665
Phone
(410) 744-0900
Fax
(410) 744-3160
NPI assigned
Feb 9, 2009
Last updated
Feb 25, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. AGNES HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2016

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

Authorized official

Name
Mr. Keith Vander Kolk
Title
President/Ceo
Phone
(667) 234-2101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A1300 MD Primary

Addresses

Primary practice location

300 Frederick Rd
Suite 200
Baltimore, MD 21228-4665

Mailing address

3585 Washington Blvd
Halethorpe, MD 21227-1676
Phone (667) 234-2149

Other names 1

  • George Thomas Grace M.D. Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090331000086 MD Part B Supplier - Ambulatory Surgical Center 9830092733 Practice locations: Catonsville, MD

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
St Agnes Healthcare IncCCN 21C0001300
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Part of
St Agnes HLTH Care

NPI Registry JSON

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456358400000",
    "number": "1720227176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3585 WASHINGTON BLVD",
            "city": "HALETHORPE",
            "state": "MD",
            "postal_code": "212271676",
            "telephone_number": "667-234-2149",
            "fax_number": "667-234-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FREDERICK RD",
            "address_2": "SUITE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212284665",
            "telephone_number": "410-744-0900",
            "fax_number": "410-744-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AGNES HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. AGNES HEALTHCARE, INC.",
        "enumeration_date": "2009-02-09",
        "last_updated": "2016-02-25",
        "status": "A",
        "authorized_official_last_name": "VANDER KOLK",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "667-234-2101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George Thomas Grace M.D. Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; 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.