NPIMap

Organization Active NPI

St. Paul Place Specialists, Inc.

  • Gynecologic Oncology Physician
  • Baltimore, MD
National Provider Identifier
1891741112
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
D0008372 Issued in MD
Legal business name
ST. PAUL PLACE SPECIALISTS, INC.
Practice address
227 St. Paul Place
6TH Floor
Baltimore, MD 21202-2001
Phone
(410) 332-9002
Fax
(410) 783-5880
NPI assigned
May 26, 2006
Last updated
Dec 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Justin Deibel
Title
Executive Vice President & Cfo
Phone
(410) 659-2905

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207VG0400X D0008372 MD
Gynecologic Oncology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207VX0201X D0008372 MD Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

227 St. Paul Place
6TH Floor
Baltimore, MD 21202-2001

Mailing address

PO Box 824173
Philadelphia, PA 19182-4173

Other identifiers 3

IdentifierTypeStateIssuer
S186OtherMDBLUECHOICE
9754OtherMDBLUE CHOICE
KT93OtherMDBC / BS OF MD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000084 MD Part B Supplier - Clinic/Group Practice 7719882943 Receives reassigned benefits from 568 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Towson, MD; Baltimore, MD; Randallstown, MD; Pikesville, MD; Lutherville Timonium, MD; Lutherville, MD; Laurel, MD; Glen Burnie, MD…

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

Locations

250 N Calvert St
Baltimore, MD 21202
Phone (410) 332-9528

7501 Osler Dr
Ste 204
Towson, MD 21204
Phone (410) 296-5715

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1891741112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824173",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191824173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 ST. PAUL PLACE",
            "address_2": "6TH FLOOR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022001",
            "telephone_number": "410-332-9002",
            "fax_number": "410-783-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. PAUL PLACE SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "DEIBEL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "410-659-2905"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MD",
            "license": "D0008372",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "MD",
            "license": "D0008372",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHOICE",
            "identifier": "S186",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "9754",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC / BS OF MD",
            "identifier": "KT93",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.