BLACKSTONE MEDICAL SERVICES LLC (NPI# 1265043897) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265043897 |
| Entity Type | Organization |
| Organization Name | BLACKSTONE MEDICAL SERVICES LLC |
| Practice Address |
4000 Blackburn Ln Ste 210 Burtonsville MD 20866-6128 |
| Mailing Address |
550 N Reo St Ste 250 Tampa FL 33609-1039 |
| Practice Telephone | 2403903136 |
| Practice Fax Number | 2403903168 |
| Mailing Telephone | 8138312727 |
| Mailing Fax Number | 8134259025 |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | VICK TIPNES (CEO) |
| Authorized Official Telephone | 8138312727 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699074716 | Blackstone Medical Services LLC | Clinic/Center | 550 N Reo St Ste 250, Tampa, FL 33609-1039 | 2011-03-16 |
| 1609169390 | Blackstone Medical Services LLC | Clinic/Center | 550 N Reo St Ste 250, Tampa, FL 33609-1039 | 2011-05-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | BLACKSTONE MEDICAL SERVICES LLC | 550 N Reo St. Ste. 106, Tampa, Florida 33609 |
| Street Address |
4000 BLACKBURN LN STE 210 |
| City | BURTONSVILLE |
| State | MD |
| Zip Code | 20866-6128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194356717 | Kristin Sagun | Psychologist | 3901 National Drive, Suite #100, Burtonsville, MD 20866 | 2020-02-02 |
| 1093299208 | Jennifer L Wood | Doula | 4301 Ambrose Ct, Burtonsville, MD 20866 | 2018-09-24 |
| 1770092363 | Carolina Mattos | Behavior Technician | 4402 Meanderwood Dr, Burtonsville, MD 20866 | 2017-09-26 |
| 1942728233 | Peggy Sue Bruce | Behavior Technician | 4401 Bender Court, Burtonsville, MD 20866 | 2017-09-06 |
| 1376919902 | Ovetta Lorraine Harris | Speech-Language Pathologist | 14705 Perrywood Drive, Burtonsville, MD 20866 | 2015-08-18 |
| 1639552540 | Theresia Ajenanyi Atechong | Home Health Aide | 13518 Greencastle Ridge Ter Apt 402, Burtonsville, MD 20866 | 2015-07-09 |
| 1720405111 | Benedict Obi | Registered Nurse | 4301 Sgar Pine Ct, Burtonsville, MD 20866 | 2014-03-24 |
| 1023430337 | Etienne Dimbeck | Home Health Aide | 3671 Autumn Glenn Circle, Boturnsville, MD 20866 | 2014-01-07 |
| 1295089001 | Lifetime Dental Care of Maryland, Badger, P.C. | Dentist | 15648 Old Columbia Pike, Burtonsville, MD 20866 | 2012-10-31 |
| 1538412515 | Dorothy Kembong Taylor | Home Health Aide | 43 Scarlet Sage Court, Burtonsville, MD 20866 | 2012-10-16 |
| Find all providers in zip 20866 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598092942 | Medicomp Inc | Physiological Laboratory | 4000 Blackburn Ln, Suite 240, Burtonsville, MD 20866-1104 | 2009-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568061869 | All-stat Portable Md, LLC | Physiological Laboratory | 12501 Prosperity Dr Ste 455, Silver Spring, MD 20904-1689 | 2020-10-19 |
| 1285131565 | American Diagnostics Services LLC | Physiological Laboratory | 2505 Lord Baltimore Dr Ste E, Windsor Mill, MD 21244-2673 | 2018-04-12 |
| 1972966075 | Sunbloom Tech Inc | Physiological Laboratory | 3266 W Springs Dr, Ellicott City, MD 21043-3270 | 2016-04-05 |
| 1316181274 | Rmi Medical Solutions LLC | Physiological Laboratory | 3531 Anderson Ln, Jarrettsville, MD 21084-1512 | 2009-04-22 |
| 1487843868 | Cardiovascular Imaging, Inc. | Physiological Laboratory | 5530 Wisconsin Ave Ste 915, Chevy Chase, MD 20815-4330 | 2007-10-22 |
| 1457456295 | Heart Savers East Coast, LLC | Physiological Laboratory | 110 W Timonium Road, Suite 1d, Timonium, MD 21093 | 2006-09-14 |
| 1386654663 | America's Favorite Sleep Center Inc. | Physiological Laboratory | 10290 Baltimore National Pike, Ellicott City, MD 21042 | 2006-08-09 |
| 1639140387 | American Diagnostics Services LLC | Physiological Laboratory | 2505 Lord Baltimore Drive, Suite E, Windsor Mill, MD 21244-2639 | 2006-01-31 |
| 1538460985 | Radiation Physics Inc | Physiological Laboratory | 10133 Bacon Dr, Beltsville, MD 20705-2102 | 2010-11-16 |
| 1588826226 | Radiation Physics Inc | Physiological Laboratory | 10133 Bacon Dr, Beltsville, MD 20705-2102 | 2008-06-25 |
| Find all providers with the same taxonomy | ||||
| City | BURTONSVILLE |
| Zip Code | 20866 |
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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.