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SOUTH MOUNTAIN FAMILY PRACTICE LLC
NPI 1487844593
Clinic/Center in Boonsboro, MD

Active since July 26, 2007
9 SAINT PAUL ST, BOONSBORO, MD 21713(301) 432-0623(301) 432-0624 Get Directions Write a Review

NPPES record last updated: June 29, 2011. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About South Mountain Family Practice Llc NPPES

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

SOUTH MOUNTAIN FAMILY PRACTICE LLC (NPI 1487844593) is a healthcare organization registered as a clinic/center in Boonsboro, Maryland and active in the NPI registry since July 2007. The organization lists William F Bodenheimer, Owner, as its authorized official.

NPPES Registry Identity

NPI1487844593
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameSOUTH MOUNTAIN FAMILY PRACTICE LLC
Location Address9 SAINT PAUL STBoonsboro, MD 21713-1334
Mailing Address9 Saint Paul StBoonsboro, MD 21713-1334 · (301) 432-0623 · Fax (301) 432-0624
Phone(301) 432-0623
Fax(301) 432-0624
Organization SubpartNo
Authorized OfficialWilliam F BodenheimerOwner · (301) 432-0623
Enumeration DateJuly 26, 2007
Last NPPES UpdateJune 29, 2011
✔ NPI 1487844593 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in MD · D0056826
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
9 SAINT PAUL ST, Boonsboro, MD 21713
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Other Identifiers 3

Medicaid864001700MD
Medicare PIN037NMD
Medicare UPING90193MD

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

South Mountain Family Practice Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateMarylandEnrollment IDO20041216000151Non-DME Part B · Clinic/Group PracticeDue dateFebruary 28, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to South Mountain Family Practice LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

William Bodenheimer, M.D.
Family Practice
NPI 1427010354
9 SAINT PAUL ST
Boonsboro, MD 21713
(301) 432-0623
✔ PECOS✔ Accepts Medicare0.2 mi

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 South Mountain Family Practice LLC's NPI number?

The NPI number for South Mountain Family Practice LLC is 1487844593. It was assigned to this organization in the NPPES registry on July 26, 2007.

Where is South Mountain Family Practice LLC located?

South Mountain Family Practice LLC is located at 9 Saint Paul St, Boonsboro, MD 21713. The listed phone number is (301) 432-0623.

What is South Mountain Family Practice LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is South Mountain Family Practice LLC enrolled in Medicare?

Yes. South Mountain Family Practice LLC is registered in the Medicare PECOS enrollment system.

When is South Mountain Family Practice LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Maryland, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through South Mountain Family Practice LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to South Mountain Family Practice LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for South Mountain Family Practice LLC was last updated on June 29, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.