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  7. NPI Record 1639367816

ROCK CREEK GERIATRIC MEDICINE
Complete NPI Record 1639367816
Family Medicine - Geriatric Medicine in Rockville, MD

NPI Status: Active since October 12, 2007

Contact Information

11140 ROCKVILLE PIKE
#348
ROCKVILLE, MD
ZIP 20852
Phone: (301) 294-1864
Fax: (301) 349-5177

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Second Line Business Practice Location Address
  17. Provider Business Practice Location Address City Name
  18. Provider Business Practice Location Address State Name
  19. Provider Business Practice Location Address Postal Code
  20. Provider Business Practice Location Address Country Code If outside U S
  21. Provider Business Practice Location Address Telephone Number
  22. Provider Business Practice Location Address Fax Number
  23. Provider Enumeration Date
  24. Last Update Date
  25. Authorized Official Last Name
  26. Authorized Official First Name
  27. Authorized Official Middle Name
  28. Authorized Official Title or Position
  29. Authorized Official Telephone Number
  30. Healthcare Provider Taxonomy Code 1
  31. Healthcare Provider Primary Taxonomy Switch 1
  32. Other Provider Identifier 1
  33. Other Provider Identifier Type Code 1
  34. Other Provider Identifier Issuer 1
  35. Is Organization Subpart
  36. Authorized Official Name Prefix Text
  37. Authorized Official Credential Text
  38. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1639367816. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1639367816
The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The last name of the provider. If the provider is an individual, this is the legal name.
The first name of the provider, if the provider is an individual.
Provider Other Organization Name: ROCK CREEK GERIATRIC MEDICINE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Other Organization Name Type Code: 3
The city name in the mailing address of the provider being identified.
Provider First Line Business Mailing Address: 11140 ROCKVILLE PIKE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing Address: #348
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address City Name: ROCKVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 208523106
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 3012941864
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 3013495177
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 11140 ROCKVILLE PIKE
The last name of the provider. If the provider is an individual, this is the legal name.
Provider Second Line Business Practice Location Address: #348
The first name of the provider, if the provider is an individual.
Provider Business Practice Location Address City Name: ROCKVILLE
The middle name of the provider, if the provider is an individual.
Provider Business Practice Location Address State Name: MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Practice Location Address Postal Code: 208523106
The code designating the provider's gender if the provider is a person.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3012941864
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider Business Practice Location Address Fax Number: 3013495177
The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
Provider Enumeration Date: 10/12/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 10/12/2007
The date that a record was last updated or changed.
Authorized Official Last Name: NAY
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: PATRICIA
The first name of the authorized official.
Authorized Official Middle Name: TOMSKO
The middle name of the authorized official.
Authorized Official Title or Position: MANAGING PARTNER
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Authorized Official Telephone Number: 3012941864
The city name in the location address of the provider being identified.
Healthcare Provider Taxonomy Code 1: 207QG0300X
The State code in the location of the provider being identified.
Healthcare Provider Primary Taxonomy Switch 1: Y
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Other Provider Identifier 1: G00023
The country code in the location address of the provider being identified.
Other Provider Identifier Type Code 1: 01
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier Issuer 1: MEDICARE GROUP NUMBER
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Is Organization Subpart: N
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Name Prefix Text: DR.
The date that a record was last updated or changed.
Authorized Official Credential Text: M.D.
The code designating the provider's gender if the provider is a person.
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP
This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.