NPIMap

Organization Active NPI

Luminis Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Bowie, MD
National Provider Identifier
1720304223
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
LUMINIS HEALTH MEDICAL GROUP, LLC
Practice address
4175 N Hanson CT Ste 203
Bowie, MD 20716-3183
Phone
(443) 481-1199
Fax
(443) 481-1495
NPI assigned
Apr 9, 2010
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Peter Odenwald
Title
VP Business Development
Phone
(443) 481-6415

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X Primary
Surgical Oncology Physician 2086X0206X

Addresses

Primary practice location

4175 N Hanson CT Ste 203
Bowie, MD 20716-3183

Mailing address

2000 Medical Pkwy Ste 409
Annapolis, MD 21401-3746
Phone (667) 204-7212

Other identifiers 4

IdentifierTypeStateIssuer
X364OtherDCBCBS
407175124MedicaidMD
CHD0AAOtherMDBCBS
407175129MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080707000490 DC Part B Supplier - Clinic/Group Practice 2860447315 Receives reassigned benefits from 400 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Washington, DC; Upper Marlboro, MD; Temple Hills, MD; Suitland, MD; Riverdale Park, MD; Laurel, MD; Bowie, MD; Largo, MD…

National Provider Directory

National Provider Directory
Tax ID family
Luminis Health Primary Care Ginger Cove225 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

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": "1270771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1720304223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MEDICAL PKWY STE 409",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013746",
            "telephone_number": "667-204-7212",
            "fax_number": "443-481-4151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 N HANSON CT STE 203",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207163183",
            "telephone_number": "443-481-1199",
            "fax_number": "443-481-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINIS HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-09",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "ODENWALD",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "VP BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "443-481-6415"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "X364",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407175124",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "CHD0AA",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407175129",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.