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Organization Active NPI

Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Leonardtown, MD
National Provider Identifier
1922258367
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER BADEN MEDICAL SERVICE INCORPORATED
Practice address
23140 Moakley St Ste 4
Leonardtown, MD 20650-2923
Phone
(301) 997-1029
Fax
(301) 997-1489
NPI assigned
Sep 23, 2008
Organization subpart
Yes
Parent organization
GREATER BADEN MEDICAL SERVICE INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Jeffrey A Kurcab
Title
Cfo
Phone
(301) 599-2172

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

23140 Moakley St Ste 4
Leonardtown, MD 20650-2923

Mailing address

7450 Albert Rd FL 3
Brandywine, MD 20613-3035
Phone (301) 888-2233

Other identifiers 1

IdentifierTypeStateIssuer
911431900MedicaidMD

Other names 1

  • Greater Baden Medical Service at Leonardtown Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081015000639 MD Part A Provider - Federally Qualified Health Center (FQHC) 4981632650 Practice locations: Leonardtown, MD

Federally qualified health center certification: CCN 211825

Legal name
GREATER BADEN MEDICAL SERVICE INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 13, 2001
Last certification
Aug 13, 2001
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 6, 1972 in MD
Enrollment address
23140 Moakley St
Ste 4
Leonardtown, MD 20650-2923
Related CCNs
211817

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Greater Baden Med SVC I15 organizations share this tax ID, including this one
Part of
Greater Baden Med SVC I

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Roxann Cooper Individual Corporate DirectorBoard Member May 1, 2021
Joan F Hepburn Individual Corporate DirectorBoard Member May 1, 2021
Dale E Speake Individual Corporate DirectorChair Jan 1, 1992
Jeffrey a Kurcab Individual Corporate OfficerCfo Jan 17, 2022 100%
W-2 Managing EmployeeCfo Jan 17, 2022 100%
Brandon Jones Individual Corporate DirectorBoard Member Apr 1, 2017
Christopher Demarco Individual Corporate OfficerCeo Jan 1, 2022 100%
Robert Harold Eaton Individual Corporate DirectorTreasurer Jan 1, 2011
Mary Ann Friis Individual Corporate DirectorVice Chair Oct 1, 2010

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1922258367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 ALBERT RD FL 3",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133035",
            "telephone_number": "301-888-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23140 MOAKLEY ST STE 4",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206502923",
            "telephone_number": "301-997-1029",
            "fax_number": "301-997-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER BADEN MEDICAL SERVICE INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER BADEN MEDICAL SERVICE INCORPORATED",
        "enumeration_date": "2008-09-23",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "KURCAB",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-599-2172"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911431900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Baden Medical Service at Leonardtown",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Leonardtown, MD

Sources for this page

Verify at the official NPI Registry.