NPIMap

Individual provider Active NPI

George H Wathen, MD PA

  • Internal Medicine Physician
  • Waldorf, MD
National Provider Identifier
1861453284
Registry record updated Feb 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0020629 Issued in MD
Practice address
11345 Pembrooke SQ
Suite 103
Waldorf, MD 20603-4804
Phone
(301) 645-8144
Fax
(301) 870-8392
NPI assigned
Mar 28, 2006
Last updated
Feb 15, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0020629 MD Primary

Addresses

Primary practice location

11345 Pembrooke SQ
Suite 103
Waldorf, MD 20603-4804

Mailing address

11345 Pembrooke SQ
Ste 103
Waldorf, MD 20603-4804
Phone (301) 645-8144

Other identifiers 2

IdentifierTypeStateIssuer
326971000MedicaidMD
110128523OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050803000425 MD Practitioner - Internal Medicine 6901834696 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Maryland School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11345 Pembrooke SQ
Suite 103
Waldorf, MD 20603-4804
Phone (301) 645-8144

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
25.51 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
85.03

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
D0020629MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203033600000",
    "number": "1861453284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11345 PEMBROOKE SQ",
            "address_2": "STE 103",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034804",
            "telephone_number": "301-645-8144",
            "fax_number": "301-870-8392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11345 PEMBROOKE SQ",
            "address_2": "SUITE 103",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034804",
            "telephone_number": "301-645-8144",
            "fax_number": "301-870-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATHEN",
        "first_name": "GEORGE",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2008-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0020629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "326971000",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110128523",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

Verify at the official NPI Registry.