KAISER PERMANENTE FREDERICK MEDICAL CENTER LABORATORY (KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC) NPI 1407999527

Clinical Medical Laboratory in Frederick, MD

NPI 1407999527 Organization Clinical Medical Laboratory CLIA Number 21D1071728 CLIA Certificate of Accreditation

About KAISER PERMANENTE FREDERICK MEDICAL CENTER LABORATORY (KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC)

Kaiser Permanente Frederick Medical Center Laboratory (kaiser Foundation Health Plan Of The Mid-atlantic States, Inc) is a provider established in Frederick, Maryland specializing in clinical medical laboratory. The NPI number of Kaiser Permanente Frederick Medical Center Laboratory (kaiser Foundation Health Plan Of The Mid-atlantic States, Inc) is 1407999527 and was assigned on February 2007. The practitioner's primary taxonomy code is 291U00000X. The provider is registered as an organization and their NPI record was last updated May 2021. The provider's other name is Kaiser Permanente Frederick Medical Center Laboratory. The authorized official of this NPI record is Deanne G Petersen (Chief Financial Officer)

The CLIA number of Kaiser Permanente Frederick Medical Center Laboratory is 21D1071728 registered as a "health maintenance organization" facility with a CLIA Certificate of Accreditation. This is a CLIA certificate is issued to Kaiser Permanente Frederick Medical Center Laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.

NPI

1407999527

Provider NameKAISER PERMANENTE FREDERICK MEDICAL CENTER LABORATORY (KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC)
Provider Location Address7190 CRESTWOOD BLVD FREDERICK, MD 21703
Provider Mailing Address2101 E JEFFERSON STREET 3 WEST KAISER PERMANENTE DATA MANAGEMENT DEPARTMENT ATT ROCKVILLE, MD 20852
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Other Organization NameKAISER PERMANENTE FREDERICK MEDICAL CENTER LABORATORY
Other Name TypeOther Name (5)
Enumeration Date02-15-2007
Last Update Date05-26-2021


Primary Taxonomy

Taxonomy Code291U00000X
ClassificationClinical Medical Laboratory
TypeLaboratories
Taxonomy Description(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.

Business Address

KAISER PERMANENTE FREDERICK MEDICAL CENTER LABORATORY
7190 CRESTWOOD BLVD
FREDERICK, MD
ZIP 21703
Phone: (240) 529-1775
Fax: (240) 529-1777

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Mailing Address

KAISER PERMANENTE FREDERICK MEDICAL CENTER LABORATORY
2101 E JEFFERSON STREET
3 WEST KAISER PERMANENTE DATA MANAGEMENT DEPARTMENT ATT
ROCKVILLE, MD
ZIP 20852
Phone: (301) 816-7446
Fax: (301) 816-7170



Authorized Official

Authorized Official Name DEANNE G PETERSEN
Authorized Official TitleCHIEF FINANCIAL OFFICER
Authorized Official Phone(301) 816-5760

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1407999527 is:

CLIA Number21D1071728
Facility TypeHEALTH MAINTENANCE ORGANIZATION
Certificate TypeCertificate of Accreditation

Other Providers at the same location


The following 12 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1003008830MS. PAULA GRACE LCSW C
Individual
Social Worker (Clinical)7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(240) 529-1700
1972844702 DIANA ERIN MCDERMOTT PHARM. D
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1760723555 ANN LOUISE HALLOCK RPH
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1609010271DR. SOKPHEARY SRORN M.D.
Individual
Family Medicine7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(800) 777-7904
1245573427 SARAH KANG-PAK
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1437272150MRS. KIMBERLY DAWN WAGNER PHARM.D.
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1477618502KAISER PERMANENTE FREDERICK MED CTR
Organization
Pharmacy (Managed Care Organization Pharmacy)7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1194868422KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC
Organization
Pharmacy (Managed Care Organization Pharmacy)7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1548347065DR. SUSAN K LOVICH MD
Individual
Pediatrics7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(240) 529-1700
1932326709 ADEDOYIN SHONEKAN M.D.
Individual
Obstetrics & Gynecology7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1700
1972762995DR. LAINE MONTGOMERY CORNELISON MD
Individual
Family Medicine7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(240) 529-1700
1700237534 SEAN DAVID BOURNE MD
Individual
Family Medicine7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1700

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The 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.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type 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 (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.