NPIMap

Organization Active NPI

Miles River Primary Care LLC

  • Internal Medicine Physician
  • Easton, MD
National Provider Identifier
1891015012
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MILES RIVER PRIMARY CARE LLC
Practice address
8579 Commerce Dr Ste 104
Easton, MD 21601-7420
Phone
(410) 822-9133
Fax
(410) 822-9513
NPI assigned
Jun 10, 2010
Last updated
May 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Tammy Smith
Title
Practice Manager
Phone
(410) 770-3206

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

8579 Commerce Dr Ste 104
Easton, MD 21601-7420

Mailing address

8579 Commerce Dr Ste 104
Easton, MD 21601-7420
Phone (410) 822-9133

Other practice location 1

618 Sunburst Hwy
Cambridge, MD 21613-2546
Phone (410) 822-9133

Other names 2

  • Miles River Physicians Former legal business name
  • MR Docs Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100903000164 MD Part B Supplier - Clinic/Group Practice 1951425545 Receives reassigned benefits from 19 practitioners
Practice locations: Cambridge, MD; Easton, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2016140Miles River Physicians8579 Commerce Drive #104, Easton, MD 21601Provider-performed microscopyNov 11, 2026

National Provider Directory

National Provider Directory

Locations

8579 Commerce Dr
Unit C
Easton, MD 21601

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1891015012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8579 COMMERCE DR STE 104",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017420",
            "telephone_number": "410-822-9133",
            "fax_number": "410-822-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8579 COMMERCE DR STE 104",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017420",
            "telephone_number": "410-822-9133",
            "fax_number": "410-822-9513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "618 Sunburst Hwy",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MD",
            "postal_code": "216132546",
            "country_code": "US",
            "telephone_number": "410-822-9133",
            "fax_number": "410-822-9513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MILES RIVER PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-10",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "410-770-3206"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miles River Physicians",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "MR Docs",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MR Docs",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.