MD Immediate Care LLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

MD IMMEDIATE CARE LLC

Practice address

504 Lewis St
Havre de Grace, MD 21078-3420

Phone

(443) 502-5311

Fax

(443) 955-5736

NPI assigned

Mar 11, 2013

Last updated

Oct 3, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rehan Khan, M.DNPI 1497796619

Title

President

Phone

(443) 243-8894

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Rehan Khan, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Bel Air, MD
  • NPI 1497796619
  Medicare reassignment NPD Authorized official
• Mamadou Sadio Diallo, FNP

  • Family Nurse Practitioner
  • Havre de Grace, MD
  • NPI 1164005104
  Medicare reassignment NPD
• Shaunyetta Conyelle Knight, CRNP

  • Family Nurse Practitioner
  • Havre de Grace, MD
  • NPI 1871152371
  Medicare reassignment NPD
• Kerry Kathryn Lewis, MSN, APRN-CNP, FNP-C

  • Family Nurse Practitioner
  • Elkridge, MD
  • NPI 1366094260
  Medicare reassignment NPD
• John S Braxton III, P.A.

  • Physician Assistant
  • Havre de Grace, MD
  • NPI 1902809734
  Medicare reassignment

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

{
    "created_epoch": "1362960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1770824195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 LEWIS ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783420",
            "telephone_number": "443-502-5311",
            "fax_number": "443-955-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 LEWIS ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783420",
            "telephone_number": "443-502-5311",
            "fax_number": "443-955-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD IMMEDIATE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-11",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "REHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-243-8894",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryanne Patricia McGovern, LGSW
• Kristen McLaurin, MSW, LCSW
• Ella McMullin
• Cheryl McNeil
• MD Family Care LLC
• Sarah Meredith
• Sandra P Mertz, RN, IBCLC
• Michael S. Presti D.P.M., P.a.
• Gianni B Migliaccio, PA-C
• Surendra Kumar Milak, M.D., F.A.C.E.P.

• Urgent Care Clinic/Center in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• Urgent Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; 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.