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PAX RIVER MEDICAL CLINIC, LLC
NPI 1083807085
General Practice in Lexington Park, MD

Active since August 22, 2007
46940 S SHANGRI LA DR, SUITE #19, LEXINGTON PARK, MD 20653(301) 863-8101(301) 863-8130 Get Directions Write a Review

NPPES record last updated: May 9, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Pax River Medical Clinic, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PAX RIVER MEDICAL CLINIC, LLC (NPI 1083807085) is a healthcare organization registered as a general practice in Lexington Park, Maryland and active in the NPI registry since August 2007. The organization lists Katherine Ann Martin, Owner, as its authorized official.

NPPES Registry Identity

NPI1083807085
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NamePAX RIVER MEDICAL CLINIC, LLC
Location Address46940 S SHANGRI LA DR, SUITE #19Lexington Park, MD 20653-1037
Mailing Address46940 S Shangri La Dr, Suite #19Lexington Park, MD 20653-1037 · (301) 863-8101 · Fax (301) 863-8130
Phone(301) 863-8101
Fax(301) 863-8130
Organization SubpartNo
Authorized OfficialKatherine Ann MartinOwner · (301) 863-8101
Enumeration DateAugust 22, 2007
Last NPPES UpdateMay 9, 2014
✔ NPI 1083807085 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in MD · H0055958
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
46940 S SHANGRI LA DR, Lexington Park, MD 20653
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Other Identifiers 4

Medicaid011218600MD
Medicare PIN479PDC
Other1437267986MD · Individual Npi #
Medicare PINC64558MD

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pax River Medical Clinic, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Pax River Medical Clinic, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Katherine Martin, DO
Family Practice
NPI 1437267986
46940 S SHANGRI LA DR SUITE 19
Lexington Park, MD 20653
(301) 863-8101
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pax River Medical Clinic, LLC's NPI number?

The NPI number for Pax River Medical Clinic, LLC is 1083807085. It was assigned to this organization in the NPPES registry on August 22, 2007.

Where is Pax River Medical Clinic, LLC located?

Pax River Medical Clinic, LLC is located at 46940 S Shangri La Dr Suite #19, Lexington Park, MD 20653. The listed phone number is (301) 863-8101.

What is Pax River Medical Clinic, LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Pax River Medical Clinic, LLC enrolled in Medicare?

Yes. Pax River Medical Clinic, LLC is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Pax River Medical Clinic, LLC was last updated on May 9, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.