NPIMap

Organization Active NPI

Shore Health System, Inc

  • Radiology Clinic/Center
  • Cambridge, MD
National Provider Identifier
1801475637
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
SHORE HEALTH SYSTEM, INC
Practice address
713 Cambridge Marketplace Blvd
Ste 2-600
Cambridge, MD 21613
Phone
(410) 822-1000
NPI assigned
Apr 7, 2021
Organization subpart
Yes
Parent organization
SHORE HEALTH SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Authorized official

Name
Kenneth Kozel
Title
President & Ceo
Phone
(410) 822-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

713 Cambridge Marketplace Blvd
Ste 2-600
Cambridge, MD 21613

Mailing address

219 S Washington St
Easton, MD 21601-2913
Phone (410) 822-1000

Other names 1

  • UM SHORE REGIONAL HEALTH DIAGNOSTICS AND IMAGING CENTER AT CAMBRIDGE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211123000142 MD Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8022906783 Practice locations: Cambridge, MD

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Shore Gynecology20 organizations share this tax ID, including this one
Part of
Shore Gynecology

Other organizations with this tax ID 19

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

View all 19

Member of 1

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

Locations

219 S Washington St
Easton, MD 21601

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1801475637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 S WASHINGTON ST",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216012913",
            "telephone_number": "410-822-1000",
            "fax_number": "410-822-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 CAMBRIDGE MARKETPLACE BLVD",
            "address_2": "STE 2-600",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "21613",
            "telephone_number": "410-822-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE HEALTH SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHORE HEALTH SYSTEM, INC",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-07-23",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "KOZEL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "410-822-1000"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UM SHORE REGIONAL HEALTH DIAGNOSTICS AND IMAGING CENTER AT CAMBRIDGE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UM SHORE REGIONAL HEALTH DIAGNOSTICS AND IMAGING CENTER AT CAMBRIDGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cambridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; 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.