NPIMap

Organization Active NPI

Maryland Real Life Designs, LLC

Doing business as Real Life Prosthetics

  • Prosthetic/Orthotic Supplier
  • Newark, DE
National Provider Identifier
1912216557
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
MARYLAND REAL LIFE DESIGNS, LLC
Doing business as
Real Life Prosthetics
Practice address
100 Biddle Ave
Suite 100
Newark, DE 19702-3981
Phone
(302) 392-1947
NPI assigned
Sep 30, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Sandra Yeater
Title
Member/Cfo
Phone
(410) 569-0606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

100 Biddle Ave
Suite 100
Newark, DE 19702-3981

Mailing address

3435 Box Hill Corporate Center Dr
Suite D
Abingdon, MD 21009-1204
Phone (410) 569-0606

Other identifiers 3

IdentifierTypeStateIssuer
4090110001OtherMDMEDICARE PROVIDER NUMBER
4090110002OtherMDMEDICARE JA
01110310MedicaidMD

Other names 1

  • Real Life Prosthetics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110629000339 DE DME Supplier - Certified Orth/Pros/Pedorthist 1355453259 1 other NPI on this enrollment
Practice locations: Newark, DE

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Maryland Real Life Designs, LLC100 Biddle Ave, Newark, DE 19702-3982(302) 392-1947 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Does not accept assignmentParticipating since May 3, 2001

National Provider Directory

National Provider Directory
Tax ID family
Maryland Real Life Designs LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 Biddle Ave
Ste 100
Newark, DE 19702
Phone (302) 392-1947

3435 Box Hill Corporate Center Dr
Ste D
Abingdon, MD 21009
Phone (410) 569-0606

3435 Box Hll Corp Center Dr
Ste D
Abingdon, MD 21009

NPI Registry JSON

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

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1912216557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 BOX HILL CORPORATE CENTER DR",
            "address_2": "SUITE D",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "210091204",
            "telephone_number": "410-569-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BIDDLE AVE",
            "address_2": "SUITE 100",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023981",
            "telephone_number": "302-392-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND REAL LIFE DESIGNS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "YEATER",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "MEMBER/CFO",
        "authorized_official_telephone_number": "410-569-0606"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "4090110001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE JA",
            "identifier": "4090110002",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01110310",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Real Life Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Real Life Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.