NPIMap

Organization Active NPI

Upper Chesapeake Surgical Associates, LLC

  • Durable Medical Equipment & Medical Supplies
  • Bel Air, MD
National Provider Identifier
1821636002
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
UPPER CHESAPEAKE SURGICAL ASSOCIATES, LLC
Practice address
2012 S Tollgate Rd Ste 100
Bel Air, MD 21015-5901
Phone
(410) 569-5155
NPI assigned
Dec 18, 2019
Last updated
Dec 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Authorized official

Name
Stephen Vincent Witman
Title
Sr VP & Cfo
Phone
(443) 643-3344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

2012 S Tollgate Rd Ste 100
Bel Air, MD 21015-5901

Mailing address

520 Upper Chesapeake Dr Ste 405
Bel Air, MD 21014-4381

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191216001287 MD DME Supplier - Physician - General Practice 8729181805 Practice locations: Bel Air, MD

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Member of 1

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

Locations

520 Upper Chesapeake Dr
Ste 405
Bel Air, MD 21014
Phone (443) 643-3347

NPI Registry JSON

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1821636002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 UPPER CHESAPEAKE DR STE 405",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 S TOLLGATE RD STE 100",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210155901",
            "telephone_number": "410-569-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CHESAPEAKE SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "WITMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "SR VP &  CFO",
        "authorized_official_telephone_number": "443-643-3344"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.