NPIMap

Organization Active NPI

St. Clements Medical Care, LLC

  • Family Medicine Physician
  • Leonardtown, MD
National Provider Identifier
1982680641
Registry record updated Mar 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0047849 Issued in MD
Legal business name
ST. CLEMENTS MEDICAL CARE, LLC
Practice address
23130 Moakley St
Leonardtown, MD 20650-2918
Phone
(301) 997-0611
Fax
(301) 997-0709
NPI assigned
Dec 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2009

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

Authorized official

Name
Thomas McCall Wilkinson, MD
Title
Owner
Phone
(301) 997-0611

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X D0055682 MD
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X D0047849 MD Primary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X D0059422 MD
Medical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AM0700X PA59937 MD
Medical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AM0700X PA66598 MD

Addresses

Primary practice location

23130 Moakley St
Leonardtown, MD 20650-2918

Mailing address

23130 Moakley St
Leonardtown, MD 20650-2918
Phone (301) 997-0611

Other identifiers 1

IdentifierTypeStateIssuer
511108100MedicaidMD

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1982680641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23130 MOAKLEY ST",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206502918",
            "telephone_number": "301-997-0611",
            "fax_number": "301-997-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23130 MOAKLEY ST",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206502918",
            "telephone_number": "301-997-0611",
            "fax_number": "301-997-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLEMENTS MEDICAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-15",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MCCALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-997-0611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0055682",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0047849",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0059422",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "PA59937",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "PA66598",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "511108100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leonardtown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.