NPIMap

Organization Active NPI

Primary Care of Germantown,LC

  • Primary Care Clinic/Center
  • Germantown, MD
National Provider Identifier
1861517336
Registry record updated Jun 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
D0061696 Issued in MD
Legal business name
PRIMARY CARE OF GERMANTOWN,LC
Practice address
6 Executive Park CT
Germantown, MD 20874-2645
Phone
(301) 515-9160
Fax
(301) 515-7388
NPI assigned
Mar 20, 2007
Last updated
Jun 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2011

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

Authorized official

Name
Dr. Sharon Xiao-Chun Yang, MD
Title
Attending Physician
Phone
(240) 688-6949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X D0061696 MD Primary

Addresses

Primary practice location

6 Executive Park CT
Germantown, MD 20874-2645

Mailing address

6 Executive Park CT
Germantown, MD 20874-2645
Phone (301) 515-9160

Other identifiers 2

IdentifierTypeStateIssuer
150491ZDG4OtherMDMEDICARE GROUP PROVIDER NUMBER
404942000MedicaidMD

Other names 1

  • evergreen medical center, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

6 Executive Park Ct
Germantown, MD 20874
Phone (301) 515-9160

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1861517336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE PARK CT",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208742645",
            "telephone_number": "301-515-9160",
            "fax_number": "301-515-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE PARK CT",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208742645",
            "telephone_number": "301-515-9160",
            "fax_number": "301-515-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF GERMANTOWN,LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "SHARON XIAO-CHUN",
        "authorized_official_title_or_position": "ATTENDING PHYSICIAN",
        "authorized_official_telephone_number": "240-688-6949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0061696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PROVIDER NUMBER",
            "identifier": "150491ZDG4",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404942000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "evergreen medical center, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Germantown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; 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.