NPIMap

Organization Active NPI

Peninsula Eye Center, P.a

  • Ambulatory Surgical Clinic/Center
  • Salisbury, MD
National Provider Identifier
1811059306
Registry record updated Nov 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A1060 Issued in MD
Legal business name
PENINSULA EYE CENTER, P.A
Practice address
101 Milford St
Salisbury, MD 21804-6952
Phone
(410) 749-9290
Fax
(410) 543-9087
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2007

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

Authorized official

Name
Mrs. Betty Jean Nock
Title
Business Office Manager
Phone
(410) 749-9290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A1060 MD Primary

Addresses

Primary practice location

101 Milford St
Salisbury, MD 21804-6952

Mailing address

101 Milford St
Salisbury, MD 21804-6952
Phone (410) 749-9290

Other identifiers 9

IdentifierTypeStateIssuer
213769OtherMAMSI
57466701OtherMDCAREFIRST BLUE CROSS
6800028OtherUNITED HEALTHCARE
2353563OtherAETNA HMO
45227OtherCOVENTRY
5575535OtherAETNA NON-HMO
778441400MedicaidMD
PH5OtherMDCAREFIRST BLUE CHOICE
0000464928MedicaidDE

Other names 1

  • Peninsula Cataract & Laser Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080229000196 MD Part B Supplier - Ambulatory Surgical Center 0244314235 Practice locations: Salisbury, MD

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Peninsula Eye Center PACCN 21C0001060
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Eye Surg PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196035200000",
    "number": "1811059306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MILFORD ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046952",
            "telephone_number": "410-749-9290",
            "fax_number": "410-543-9087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MILFORD ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046952",
            "telephone_number": "410-749-9290",
            "fax_number": "410-543-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA EYE CENTER, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-11-26",
        "status": "A",
        "authorized_official_last_name": "NOCK",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "410-749-9290",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "213769",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS",
            "identifier": "57466701",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "6800028",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2353563",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "45227",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5575535",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "778441400",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CHOICE",
            "identifier": "PH5",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000464928",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peninsula Cataract & Laser Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; 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.