NPIMap

Organization Active NPI

MGMC, LLC

  • General Practice Physician
  • Washington, DC
National Provider Identifier
1891797148
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MGMC, LLC
Practice address
3800 Reservoir Rd NW
Washington, DC 20007-2113
Phone
(888) 896-1400
NPI assigned
Jun 1, 2005
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Stephanie Schneider
Title
VP
Phone
(703) 558-1403

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 972

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 972

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031118000305 MD Part B Supplier - Clinic/Group Practice 9537073119 Receives reassigned benefits from 122 practitioners
1 other NPI on this enrollment
Practice locations: White Plain, MD; Waldorf, MD; Prince Frederick, MD; Mt Airy, MD; Leonardtown, MD; Frederick, MD; Charlotte Hall, MD; Baltimore, MD…
O20031220000056 DC Part B Supplier - Clinic/Group Practice 9537073119 Receives reassigned benefits from 951 practitioners
2 other NPIs on this enrollment
Practice locations: Reston, VA; Rockville, MD; Silver Spring, MD; Washington, DC; Fairfax, VA; Olney, MD; Alexandria, VA; Annandale, VA…
O20110329000024 VA Part B Supplier - Clinic/Group Practice 9537073119 Receives reassigned benefits from 22 practitioners
1 other NPI on this enrollment
Practice locations: Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

3800 Reservoir Rd NW
Ste 2
Washington, DC 20007

219 50th St SE
Washington, DC 20019
Phone (412) 498-1360

3800 Reservoir Rd NW
Ste 5CCC
Washington, DC 20007

29955 Three Notch Rd
Ste 201
Charlotte Hall, MD 20622

40900 Merchants Ln
Unit 102
Leonardtown, MD 20650
Phone (301) 977-1315

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

3800 Reservoir Rd NW
Washington, DC 20007-2113

Mailing address

PO Box 418283
Boston, MA 02241-8283

Other identifiers 5

NPPES NPI Registry
IdentifierTypeStateIssuer
W678OtherDCBLUESHIELD ADULT PCP GRP#
220004006MedicaidMD
6555OtherDCBLUE SHIELD GROUP NUMBER
W676OtherDCBLUE SHIELD PEDS PCP GRP#
027332900MedicaidDC

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 28, 2024.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1891797148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 418283",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022418283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 RESERVOIR RD NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200072113",
            "telephone_number": "888-896-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGMC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "SCHNEIDER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "703-558-1403"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD ADULT PCP GRP#",
            "identifier": "W678",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220004006",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "6555",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PEDS PCP GRP#",
            "identifier": "W676",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027332900",
            "state": "DC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.