KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC (NPI# 1366781700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366781700 |
| Entity Type | Organization |
| Organization Name | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC |
| Other Organization Name | LARGO ASC |
| Practice Address |
1221 Mercantile Ln Largo MD 20774-5374 |
| Mailing Address |
2101 E Jefferson St 3 West Rockville MD 20852-4908 |
| Practice Telephone | 3016185500 |
| Mailing Telephone | 3018167446 |
| Mailing Fax Number | 3018167170 |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |
| Authorized Official Name | DEANNE G PETERSEN (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 3018165760 |
| Is Organization Subpart | Y |
| Parent Organization Name | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Largo ASC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073953873 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Pharmacy | 22370 Davis Dr, Suite 190, Sterling, VA 20164-5367 | 2013-06-26 |
| 1457416000 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Pharmacy | 1890 Metro Center Drive, Reston, VA 20190-5276 | 2006-12-26 |
| 1710045299 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Pharmacy | 655 Watkins Mill Road, Gaithersburg, MD 20879-3323 | 2006-12-05 |
| 1376601872 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Radiology | 10410 North Kensington Parkway, Kensington, MD 20895-2138 | 2006-12-05 |
| 1215002258 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Pharmacy | 7141 Security Boulevard, Baltimore, MD 21244-1811 | 2006-11-22 |
| 1386183713 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Pharmacy | 22370 Davis Dr, Suite 190, Sterling, VA 20164-5367 | 2017-02-17 |
| 1942546486 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Clinic/Center | 1701 Twin Springs Rd, Halethorpe, MD 21227-3553 | 2013-01-02 |
| 1104199421 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Clinical Medical Laboratory | 8008 Westpark Dr, Mc Lean, VA 22102-3109 | 2012-02-16 |
| 1245512110 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Clinical Medical Laboratory | 655 Watkins Mill Rd, Gaithersburg, MD 20879-3323 | 2011-09-15 |
| 1881849255 | Kaiser Foundation Health Plan of The Mid-atlantic States,inc | Health Maintenance Organization | 1201 Hospital Dr, Fredericksburg, VA 22401-8428 | 2008-11-26 |
| Street Address |
1221 MERCANTILE LN |
| City | LARGO |
| State | MD |
| Zip Code | 20774-5374 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164425419 | Stephen J Ilario | Orthopaedic Surgery | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2005-05-31 |
| 1780215020 | Malika Tamara Haylock-jones | Nurse Practitioner | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2020-01-27 |
| 1346888427 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-12-19 |
| 1164069449 | Ashasha Tselat Sumbatyan | Physical Therapy Assistant | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-12-05 |
| 1598316184 | Deepa L Cruz | Registered Nurse | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-09-25 |
| 1639720204 | Charmaine Andra Mckie | Registered Nurse | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-09-25 |
| 1669028338 | Shanelle Moore | Family Medicine | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-08-17 |
| 1356815112 | Nanah Hannah Sevalie | Nurse Practitioner | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-01-15 |
| 1215436183 | Shadana Maddox | Pharmacist | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2018-02-06 |
| 1336650878 | Kyla Trenay Scott | Registered Nurse | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2017-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922637156 | Marie Charlotte Teboutsou Tsodzou | Nurse Practitioner | 9317 Lavall Drive, Upper Marlboro, MD 20774 | 2020-04-08 |
| 1467093443 | Richland Support Services Corp. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11551 Joyceton Drive, Upper Marlboro, MD 20774 | 2019-10-01 |
| 1770134124 | Alan L Kahn | Counselor | 301 Largo Rd., Largo, MD 20774 | 2019-09-26 |
| 1619522034 | Francisca Ifeoma Alintah | Registered Nurse | 511 Dennis Magruder Dr., Upper Marlboro, MD 20774 | 2019-08-02 |
| 1609337146 | Crystal Osuchukwu | Counselor | 1300 Mccormick Dr, Upper Marlboro, MD 20774 | 2019-03-27 |
| 1861968489 | Collaborative Concepts of Maryland | Counselor | 1400 Mercantile Lane, Suite 208, Largo, MD 20774 | 2018-10-22 |
| 1073097622 | Triple Angels Homecare Services, Inc. | In Home Supportive Care | 1210 Dixie Bowie Way, Upper Marlboro, MD 20774 | 2018-09-19 |
| 1922589654 | Optimum Resource Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 711 Harry S. Truman Dr, Unit #105, Largo, MD 20774 | 2018-08-21 |
| 1811475254 | Kolawole Richard Olatunde | Home Health Aide | 11405 Villa Court, Upper Marlboro, MD 20774 | 2018-07-28 |
| 1548747769 | Tiara Williams | Counselor | 15207 Harriet Clotilda Way, Upper Marlboro, MD 20774 | 2018-07-20 |
| Find all providers in zip 20774 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730500935 | Bardmoor Surgery Center LLC | Clinic/Center | 8787 Bryan Dairy Rd Ste 300, Largo, FL 33777-1252 | 2013-12-16 |
| 1881905792 | Surgcenter Pinellas, LLC | Clinic/Center | 12416 66th St N, Ste D, Largo, FL 33773-3430 | 2010-06-24 |
| 1336100189 | St Michaels Surgery Center Inc. | Clinic/Center | 1018 W Bay Dr, Largo, FL 33770-3225 | 2006-03-31 |
| 1366710741 | Eye Physicians of Pinellas, Pa | Clinic/Center | 148 13th St Sw, Largo, FL 33770-3127 | 2011-12-13 |
| 1598927147 | Morton Plant Mease Health Services Inc | Clinic/Center | 8787 Bryan Dairy Rd, Largo, FL 33777-1251 | 2008-06-25 |
| 1265522478 | Landover Ambulatory Surgery, Lp | Clinic/Center | 1300 Mercantile Ln, Suite 190, Largo, MD 20774-5327 | 2006-10-16 |
| 1184621864 | Largo Ambulatory Surgery Center LLC | Clinic/Center | 148 13th St Sw, Largo, FL 33770-3127 | 2005-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807961 | Vascular Surgery Center of Abingdon | Clinic/Center | 3435 Box Hill Corporate Center Dr Ste H, Abingdon, MD 21009-1204 | 2020-10-02 |
| 1518570084 | Eastside Anesthesia LLC | Clinic/Center | 19 Fontana Ln Ste 104, Rosedale, MD 21237-3027 | 2020-08-25 |
| 1215548524 | Summit Ambulatory Surgical Center, LLC | Clinic/Center | 800 Bestgate Rd Ste 200, Annapolis, MD 21401-3016 | 2020-08-11 |
| 1861001372 | Bay Surgery Centers LLC | Clinic/Center | 810 Bestgate Rd Ste 120, Annapolis, MD 21401-3033 | 2020-07-30 |
| 1417566217 | Clearway Surgery Center of Easton, LLC | Clinic/Center | 598 Cynwood Dr Ste 103, Easton, MD 21601-3875 | 2020-07-28 |
| 1932718822 | Charles Regional Surgical Center LLC | Clinic/Center | 5 North Laplata Court, 2nd Floor, Laplata, MD 20646 | 2020-07-27 |
| 1528680865 | Meridian Surgery Center LLC | Clinic/Center | 19638 Leitersburg Pike Ste 205, Hagerstown, MD 21742-1515 | 2020-05-09 |
| 1346862869 | Nspc Surgery Center of Maryland, LLC | Clinic/Center | 6710 Oxon Hill Rd Ste 550b, Oxon Hill, MD 20745-1117 | 2020-05-07 |
| 1225665292 | Annapolis Endoscopy Center LLC | Clinic/Center | 1419 Forest Dr Ste 105, Annapolis, MD 21403-1474 | 2020-03-26 |
| 1992345748 | Podiatry Associates Ambulatory Surgical Centers LLC | Clinic/Center | 9105 Franklin Square Dr Ste 206, Baltimore, MD 21237-3954 | 2020-01-09 |
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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.