Organization Active NPI

SMDS LLC

  • Family Medicine Physician
  • Potomac Falls, VA
National Provider Identifier
1891424123
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SMDS LLC
Practice address
20535 Earhart PL
Potomac Falls, VA 20165-3581
Phone
(248) 736-3561
NPI assigned
Jun 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Authorized official

Name
Ms. Krystle Brown
Title
Billing Manager
Phone
(410) 800-6251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

20535 Earhart PL
Potomac Falls, VA 20165-3581

Mailing address

522 Red Raspberry Ter
Leesburg, VA 20175-5427
Phone (248) 736-3561

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220727000302 VA Part B Supplier - Clinic/Group Practice 4688056427 Receives reassigned benefits from 1 practitioner
Practice locations: Potomac Falls, VA

National Provider Directory

National Provider Directory

Locations

20535 Earhart Pl
Sterling, VA 20165
Phone (703) 404-5205

Practitioners & affiliated clinicians

Practitioners 1

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": "1654819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1891424123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 RED RASPBERRY TER",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201755427",
            "telephone_number": "248-736-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20535 EARHART PL",
            "city": "POTOMAC FALLS",
            "state": "VA",
            "postal_code": "201653581",
            "telephone_number": "248-736-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "410-800-6251",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Potomac Falls, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; 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.