NPIMap

Organization Active NPI

Fairhill Family Medicine Specialists, LLC

  • Family Medicine Physician
  • Elkton, MD
National Provider Identifier
1811942311
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAIRHILL FAMILY MEDICINE SPECIALISTS, LLC
Practice address
361 Fair Hill Dr
Elkton, MD 21921-2512
Phone
(410) 620-7260
Fax
(410) 620-7262
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Bonni Roberts, D.O.NPI 1316904121
Title
Physician
Phone
(410) 620-7260

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

361 Fair Hill Dr
Elkton, MD 21921-2512

Mailing address

361 Fair Hill Dr
Elkton, MD 21921-2512
Phone (410) 620-7260

Other identifiers 2

IdentifierTypeStateIssuer
189CFAOtherMDCAREFIRST GROUP NUMBER
DE0145OtherMDMCR RAILROAD GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050628001369 MD Part B Supplier - Clinic/Group Practice 6406892660 Receives reassigned benefits from 3 practitioners
Practice locations: Elkton, MD

National Provider Directory

National Provider Directory

Locations

361 Fair Hill Dr
Elkton, MD 21921
Phone (410) 620-7260

Practitioners & affiliated clinicians

Practitioners 4

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": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811942311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 FAIR HILL DR",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219212512",
            "telephone_number": "410-620-7260",
            "fax_number": "410-620-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 FAIR HILL DR",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219212512",
            "telephone_number": "410-620-7260",
            "fax_number": "410-620-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHILL FAMILY MEDICINE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "BONNI",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "410-620-7260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST GROUP NUMBER",
            "identifier": "189CFA",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR RAILROAD GROUP",
            "identifier": "DE0145",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.