NPIMap

Organization Active NPI

Maryland Imaging Network PC

  • Diagnostic Radiology Physician
  • Waldorf, MD
National Provider Identifier
1952138117
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MARYLAND IMAGING NETWORK PC
Practice address
10400 Odonnell PL Ste 100
Waldorf, MD 20603-7290
Phone
(410) 298-0454
Fax
(301) 694-2606
NPI assigned
Sep 19, 2024
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MARYLAND IMAGING NETWORK PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Authorized official

Name
John Vernon Crues, M.D.
Title
President
Phone
(310) 445-2843

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X NU
Diagnostic Radiology Physician 2085R0202X NU Primary
Vascular & Interventional Radiology Physician 2085R0204X NU

Addresses

Primary practice location

10400 Odonnell PL Ste 100
Waldorf, MD 20603-7290

Mailing address

10461 Mill Run Cir Ste 1020
Owings Mills, MD 21117-5544
Phone (443) 436-1221

Other names 1

  • MIN - O'Donnell Place Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191202001049 MD Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 71 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Glen Burnie, MD; Highland, MD; Laurel, MD; Lutherville Timonium, MD; New Market, MD; North Beach, MD; Prince Frederick, MD…
O20221130002395 DC Part B Supplier - Clinic/Group Practice 6103259304 Receives reassigned benefits from 42 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Potomac, MD; Washington, DC; Rockville, MD; Silver Spring, MD; Upper Marlboro, MD; Vienna, VA; Alexandria, VA; Arlington, VA…

Other NPIs on the same Medicare enrollment 8

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2041795Ars an Affiliate of Maryland Imaging Network10400 Odonnell PL, Waldorf, MD 20603Certificate of waiverMay 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Maryland Imaging Network PC8 organizations share this tax ID, including this one
Part of
Maryland Imaging Network PC

Other organizations with this tax ID 7

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

Locations

10400 Odonnell Pl
Ste 100
Waldorf, MD 20603
Phone (401) 298-0454

10400 Odonnell Pl
Ste 1400
Waldorf, MD 20603

Ownership & related parties

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 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1952138117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 MILL RUN CIR STE 1020",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175544",
            "telephone_number": "443-436-1221",
            "fax_number": "443-436-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 ODONNELL PL STE 100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206037290",
            "telephone_number": "410-298-0454",
            "fax_number": "301-694-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND IMAGING NETWORK PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYLAND IMAGING NETWORK PC",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "CRUES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-445-2843",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIN - O'Donnell Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.