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SOUTH RIVER INTERNAL MEDICINE, PA
NPI 1710131024
Internal Medicine in Edgewater, MD

Active since November 13, 2008CLIA 21D1011182 · Waiver
3168 BRAVERTON ST STE 250, EDGEWATER, MD 21037(410) 956-1600(410) 956-7900 Get Directions Write a Review

NPPES record last updated: September 2, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 2, 2024, Aug 6, 2024, Aug 4, 2024 and 2 more (5 updates tracked since 2020).

About South River Internal Medicine, Pa NPPES

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

SOUTH RIVER INTERNAL MEDICINE, PA (NPI 1710131024) is a healthcare organization registered as an internal medicine in Edgewater, Maryland and active in the NPI registry since November 2008. The organization holds a CLIA Waiver certificate valid through April 2, 2027 and lists Renee Lynn Nye, Ama/front Office Manager, as its authorized official.

NPPES Registry Identity

NPI1710131024
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSOUTH RIVER INTERNAL MEDICINE, PA
Location Address3168 BRAVERTON ST STE 250Edgewater, MD 21037-2682
Mailing Address3168 Braverton St, Suite 250Edgewater, MD 21037-2674 · (410) 956-1600 · Fax (410) 956-7900
Phone(410) 956-1600
Fax(410) 956-7900
Organization SubpartNo
Authorized OfficialRenee Lynn NyeAma/front Office Manager · (410) 956-1600
Enumeration DateNovember 13, 2008
Last NPPES UpdateSeptember 2, 20245 updates tracked since enumeration
NPPES CertifiedSeptember 2, 2024
✔ NPI 1710131024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MD · D58166
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3168 BRAVERTON ST STE 250, Edgewater, MD 21037
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Other Identifiers 1

Medicaid514113300MD

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D1011182

South River Internal Medicine · Edgewater, MD
Active · expires Apr 2, 2027
CLIA Number21D1011182
Laboratory TypePhysician Office
Certificate Effective DateApril 3, 2025
Certificate Expiration DateApril 2, 2027
Laboratory DirectorEric C. Marcalus MD
Laboratory Phone(410) 956-1600
Laboratory LocationSouth River Internal Medicine3168 Braverton Road, Edgewater, MD 21037
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ERIC CHARLES MARCALUS MD
Internal Medicine
3168 BRAVERTON ST STE 250
EDGEWATER, MD 21037
Anne Arundel County (410) 956-1600
HEARING & BALANCE SOLUTIONS, LLC
Audiologist-Hearing Aid Fitter
3168 BRAVERTON ST STE 250
EDGEWATER, MD 21037
Anne Arundel County (443) 924-7320
DR. KRISTIN A KROTZ AU.D.
Audiologist-Hearing Aid Fitter
3168 BRAVERTON ST STE 250
EDGEWATER, MD 21037
Anne Arundel County (443) 924-7320

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 River Internal Medicine, PA's NPI number?

The NPI number for South River Internal Medicine, PA is 1710131024. It was assigned to this organization in the NPPES registry on November 13, 2008.

Where is South River Internal Medicine, PA located?

South River Internal Medicine, PA is located at 3168 Braverton St Ste 250, Edgewater, MD 21037. The listed phone number is (410) 956-1600.

What is South River Internal Medicine, PA's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does South River Internal Medicine, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 21D1011182) is associated with this NPI, valid through April 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for South River Internal Medicine, PA was last updated on September 2, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.