Organization Active NPI

Fallsgrove Endoscopy Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Rockville, MD
National Provider Identifier
1972141455
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
FALLSGROVE ENDOSCOPY CENTER, LLC
Practice address
15001 Shady Grove Rd Ste 400 4TH Floor
Rockville, MD 20850-6352
Phone
(215) 589-9024
Fax
(833) 705-6301
NPI assigned
Dec 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Authorized official

Name
Maybell Campbell
Title
Administrator
Phone
(301) 800-7001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

15001 Shady Grove Rd Ste 400 4TH Floor
Rockville, MD 20850-6352

Mailing address

15001 Shady Grove Rd Ste 4004TH
Rockville, MD 20850-6352
Phone (301) 800-7001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200127001539 DC Part B Supplier - Ambulatory Surgical Center 4082049721 Practice locations: Rockville, MD

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Fallsgrove Endoscopy Center LLCCCN 21C0001628
Medicare certification status
ActiveFrom the Provider of Services file

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
21D2179921Fallsgrove Endoscopy Center LLC15001 Shady Grove #400, Rockville, MD 20850Certificate of waiverMar 3, 2028

National Provider Directory

National Provider Directory

Locations

15001 Shady Grove Rd
Ste 4004TH
Rockville, MD 20850

Practitioners & affiliated clinicians

Practitioners 1

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": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1972141455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15001 SHADY GROVE RD STE 4004TH",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506352",
            "telephone_number": "301-800-7001",
            "fax_number": "301-800-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15001 SHADY GROVE RD STE 400 4TH FLOOR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506352",
            "telephone_number": "215-589-9024",
            "fax_number": "833-705-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLSGROVE ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-16",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "MAYBELL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-800-7001"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; 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.