NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc

Doing business as Shady Grove Medical Center Pharmacy

  • Managed Care Organization Pharmacy
  • Rockville, MD
National Provider Identifier
1871651349
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Managed Care Organization PharmacyTaxonomy code 3336M0003X
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC
Doing business as
Shady Grove Medical Center Pharmacy
Practice address
1396 Piccard Drive
Rockville, MD 20850-4302
Phone
(301) 548-5755
Fax
(301) 548-5701
NPI assigned
Dec 5, 2006
Last updated
Oct 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

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

Authorized official

Name
Colleen Swinton
Title
Credentialing Director
Phone
(301) 257-2797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Managed Care Organization Pharmacy 3336M0003X NU Primary

Addresses

Primary practice location

1396 Piccard Drive
Rockville, MD 20850-4302

Mailing address

4000 Garden City Dr
Hyattsville, MD 20785-2418
Phone (301) 816-2424

Other names 1

  • Shady Grove Medical Center Pharmacy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Found HLTH Plan169 organizations share this tax ID, including this one
Part of
Kaiser Found HLTH Plan

Organizations with this tax ID in the same state 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760054400000",
    "number": "1871651349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 GARDEN CITY DR",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207852418",
            "telephone_number": "301-816-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1396 PICCARD DRIVE",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504302",
            "telephone_number": "301-548-5755",
            "fax_number": "301-548-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC",
        "enumeration_date": "2006-12-05",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A",
        "authorized_official_last_name": "SWINTON",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "301-257-2797"
    },
    "taxonomies": [
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2101 East Jefferson Street",
            "city": "Rockville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208524908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Shady Grove Medical Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shady Grove Medical Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2025; 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.