NPIMap

Organization Active NPI

Princess Anne Family Practice

  • Family Medicine Physician
  • Princess Anne, MD
National Provider Identifier
1831183169
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRINCESS ANNE FAMILY PRACTICE
Practice address
30434 Mount Vernon Rd
Princess Anne, MD 21853-1400
Phone
(410) 651-0350
Fax
(410) 651-4857
NPI assigned
Sep 1, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Authorized official

Name
Mr. Charles Donald Stegman Jr., MDNPI 1184616419
Title
President
Phone
(410) 651-0350

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

30434 Mount Vernon Rd
Princess Anne, MD 21853-1400

Mailing address

30434 Mount Vernon Rd
Princess Anne, MD 21853-1400
Phone (410) 651-0350

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060321000239 MD Part B Supplier - Clinic/Group Practice 5496762858 Receives reassigned benefits from 4 practitioners
Practice locations: Princess Anne, MD

National Provider Directory

National Provider Directory

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": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1831183169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30434 MOUNT VERNON RD",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218531400",
            "telephone_number": "410-651-0350",
            "fax_number": "410-651-4857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30434 MOUNT VERNON RD",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218531400",
            "telephone_number": "410-651-0350",
            "fax_number": "410-651-4857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCESS ANNE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "STEGMAN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-651-0350",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princess Anne, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.