NPIMap

Organization Active NPI

Civista Pediatric Hospitalist Group

  • Pediatrics Physician
  • La Plata, MD
National Provider Identifier
1841525540
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CIVISTA PEDIATRIC HOSPITALIST GROUP
Practice address
5 Garrett Ave
La Plata, MD 20646-5960
Phone
(301) 609-4000
NPI assigned
Oct 14, 2009
Last updated
Oct 22, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
CIVISTA MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Authorized official

Name
Mr. Erik Boas
Title
Chief Financial Officer
Phone
(301) 609-4130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

5 Garrett Ave
La Plata, MD 20646-5960

Mailing address

5 Garrett Ave
PO Box 1070
La Plata, MD 20646-5960
Phone (301) 609-4000

National Provider Directory

National Provider Directory
Tax ID family
Physicians Memorial Hos2 organizations share this tax ID, including this one
Part of
Physicians Memorial Hos

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1255478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1841525540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "address_2": "PO BOX 1070",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960",
            "telephone_number": "301-609-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960",
            "telephone_number": "301-609-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA PEDIATRIC HOSPITALIST GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIVISTA MEDICAL CENTER",
        "enumeration_date": "2009-10-14",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "BOAS",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-609-4130",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.