NPIMap

Organization Active NPI

Luminis Health Medical Group, LLC

  • Surgical Oncology Physician
  • Bowie, MD
National Provider Identifier
1851710552
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
D68660 Issued in MD
Legal business name
LUMINIS HEALTH MEDICAL GROUP, LLC
Practice address
4175 N Hanson CT
Suite 201
Bowie, MD 20716-3179
Phone
(443) 481-3713
NPI assigned
Apr 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Peter Odenwald
Title
Vice President
Phone
(443) 481-6415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086X0206X D68660 MD Primary

Addresses

Primary practice location

4175 N Hanson CT
Suite 201
Bowie, MD 20716-3179

Mailing address

PO Box 12622
Belfast, ME 04915-4017
Phone (443) 481-6538

Other names 1

  • Annapolis Surgical Oncology Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080707000490 DC Part B Supplier - Clinic/Group Practice 2860447315 Receives reassigned benefits from 400 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Washington, DC; Upper Marlboro, MD; Temple Hills, MD; Suitland, MD; Riverdale Park, MD; Laurel, MD; Bowie, MD; Largo, MD…

National Provider Directory

National Provider Directory
Tax ID family
Anne Arundel Phys Group LLC221 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners 5

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": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1851710552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12622",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154017",
            "telephone_number": "443-481-6538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 N HANSON CT",
            "address_2": "SUITE 201",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207163179",
            "telephone_number": "443-481-3713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINIS HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-09",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "ODENWALD",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "443-481-6415"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": "MD",
            "license": "D68660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Annapolis Surgical Oncology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Annapolis Surgical Oncology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.