MALCOLM GROW MEDICAL CENTER (NPI# 1215994660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215994660 |
| Entity Type | Organization |
| Organization Name | MALCOLM GROW MEDICAL CENTER |
| Other Organization Name | 779TH MEDICAL GROUP |
| Practice Address |
1050 W Perimeter Rd Mdss Sgsr Andrews Afb MD 20762-6600 |
| Practice Telephone | 2408578658 |
| Practice Fax Number | 2408577700 |
| Mailing Telephone | 2408578658 |
| Mailing Fax Number | 2408577700 |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2014-05-21 |
| Authorized Official Name | THERESA M. MITCHELL (AIR FORCE UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities | ||
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | NCPDP | 21-25373 | 01 |
| Other Name | Type Code |
|---|---|
| 779th Medical Group | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508917501 | Malcolm Grow Medical Center | Military Hospital | 1050 W Perimeter Rd, 79mdos-sgohy, Andrews Afb, MD 20762-6601 | 2007-01-16 |
| Street Address |
1050 W PERIMETER RD MDSS SGSR |
| City | ANDREWS AFB |
| State | MD |
| Zip Code | 20762-6600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114360898 | Lori Lynn Littlejohn | Nurse Anesthetist, Certified Registered | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2013-04-11 |
| 1770838948 | Heidi Derade | Military Health Care Provider | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2012-07-13 |
| 1285916601 | Janet Denise Cochran | Social Worker | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2011-09-12 |
| 1699054288 | Jose Antonio Rodriguez | Military Health Care Provider | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2011-08-12 |
| 1497081574 | Lindsay Kate Gregus | Military Health Care Provider | 1050 W Perimeter Rd, Sgoic, Andrews Afb, MD 20762-6601 | 2009-10-26 |
| 1093049827 | Jon Burrill Geno | Nurse Practitioner | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2009-09-26 |
| 1740419084 | Christopher Clement Rhoney | Military Health Care Provider | 1050 W Perimeter Rd, 779 Mdg/sgn, Andrews Afb, MD 20762-6601 | 2009-07-08 |
| 1689800278 | Dexter Dewayne Robinson | Military Health Care Provider | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2009-06-09 |
| 1942444815 | Erica Marie Jasper | Military Health Care Provider | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2009-04-23 |
| 1760625040 | Teresa Rollins | Military Health Care Provider | 1050 W Perimeter Rd, Andrews Afb, MD 20762-6601 | 2009-04-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982210423 | Kevin Wang | Dentist | 1057 W Perimeter Rd, Prince County, MD 20762 | 2020-09-21 |
| 1306467667 | Priscilla Andalia | Student in an Organized Health Care Education/Training Program | 1065 W. Perimeter Road, Jb Andrews, MD 20762 | 2020-04-28 |
| 1275162877 | Gabi Im | Dentist | 1065 W Perimeter Rd., Joint Base Andrews, Apo, AA 20762 | 2020-04-06 |
| 1083240139 | Shirley Ye | Student in an Organized Health Care Education/Training Program | 1025 Boston Rd, Joint Base Andrews, MD 20762 | 2020-03-20 |
| 1255988853 | Songxuan Zhou Niemtzow | Acupuncturist | Acupuncture Center and Integrative Medicine Center, 1060 West Perimeter Road, Joint Base Andrews, MD 20762 | 2019-08-20 |
| 1487010971 | Tracy Ellen Ambos | Social Worker | 5100 Fetcher Avenue, Joint Base Andrews, MD 20762 | 2016-01-13 |
| 1154718450 | Ryan Mason Kring | Emergency Medicine | Malcolm Grow Medical Clinics, 1060 W Perimeter Rd, Joint Base Andrews, MD 20762 | 2015-04-24 |
| 1518206044 | Jeremy Gallman | Veterinarian | 1781 Arnold Ave., Joint Base Andrews, MD 20762 | 2013-02-04 |
| 1043556418 | Kimberly Mccoy-singh | Physical Therapist | 1075 West Perimeter Rd., 779 Mdos/sgoy, Joint Base Andrews, MD 20762 | 2012-12-12 |
| 1417215799 | Alexander Rostam Kheradi | Emergency Medicine | 1050 West Perimeter Road, Joint Base Andrews, MD 20762 | 2012-04-24 |
| Find all providers in zip 20762 | ||||
| Taxonomy Code | 261QM1101X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military and U.S. Coast Guard Ambulatory Procedure |
| That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598778623 | Uscg | Clinic/Center | 2401 Hawkins Point Rd, Baltimore, MD 21226-1797 | 2006-08-13 |
| City | ANDREWS AFB |
| Zip Code | 20762 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.