Calverthealth Medical Group, LLC
Organization Active NPI Family Medicine Physician · Solomons, MD
NPI 1891532818 · NPPES record last updated Jul 10, 2024
Key facts
- NPI
- 1891532818
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CALVERTHEALTH MEDICAL GROUP, LLC
- Practice address
- 14090 HG Trueman Rd Ste 2100
Solomons, MD 20688-3151 - Phone
- (410) 394-3712
- Fax
- (410) 394-3714
- NPI assigned
- Jul 9, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- CALVERT HEALTH SYSTEM, INC.
Authorized official
- Name
- Carolyn Heithaus
- Title
- Cfo
- Phone
- (410) 535-8236
Other NPIs on the same Medicare enrollment 20
Corporate family (same tax ID) 19
Practitioners 2
-
Karen Ann O'Connor, C.R.N.P.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091215000115 | MD | Part B Supplier - Clinic/Group Practice | 2163562695 |
Receives reassigned benefits from 55 practitioners 20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Prince Frederick, MD; Waldorf, MD; Solomons, MD; North Beach, MD |
National Provider Directory
- Tax ID family
- Calverthealth Medical Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Gastroenterology Physician |
207RG0100X | |||
| Hematology & Oncology Physician |
207RH0003X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Surgery Physician |
208600000X | |||
| Vascular Surgery Physician |
2086S0129X | |||
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
14090 HG Trueman Rd Ste 2100
Solomons, MD 20688-3151
Mailing address
100 Hospital Rd
Prince Frederick, MD 20678-4017
Phone (410) 414-4791
Other providers in Solomons, MD
- Calverthealth Medical Center, Inc.
- Calverthealth Medical Center, Inc.
- Calverthealth Medical Center, Inc.
- Calverthealth Medical Group, LLC
- Calverthealth Medical Group, LLC
- Capital Foot and Ankle Care Centre, PA
- Elaine E. Castles
- Centers for Advanced Orthopaedics, LLC
- Wing Chan
- Kyle J Clover
All providers in Solomons, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.