Southern Maryland Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D78727 Issued in MD

Legal business name

SOUTHERN MARYLAND PRIMARY CARE, LLC

Practice address

3460 Old Washington Rd
Suite 203a
Waldorf, MD 20602-3240

Phone

(301) 638-9670

Fax

(301) 638-7558

NPI assigned

Sep 26, 2007

Organization subpart

No

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

Authorized official

Name

Niran P Sharma, MD

Title

Owner

Phone

(301) 638-9670

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 2

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

• Tammy Fusilier, CRNP

  • Gerontology Nurse Practitioner
  • Waldorf, MD
  • NPI 1366096034
  Medicare reassignment
• Collins P Sein, MD

  • Internal Medicine Physician
  • Waldorf, MD
  • NPI 1699769554
  Medicare reassignment

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1831386630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1558",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206041558",
            "telephone_number": "301-638-9670",
            "fax_number": "301-638-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 OLD WASHINGTON RD",
            "address_2": "SUITE 203A",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023240",
            "telephone_number": "301-638-9670",
            "fax_number": "301-638-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MARYLAND PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2012-12-18",
        "status": "A",
        "authorized_official_last_name": "SHARMA",
        "authorized_official_first_name": "NIRAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-638-9670",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D78727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431203100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "F247",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southern Maryland Physical Therapy, Inc
• Southern Maryland Pulmonary & Critical Care, P.a.
• Southern Maryland Speech and Language Services
• Katelyn Southwick, DPT
• Sovereign Consulting Group LLC
• Speaking of...

• Family Medicine Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; 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.