Basic Information
| Provider Information | |||||||||
| NPI: | 1831109537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIGITRACE CARE SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SLEEPMED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | SUITE 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359757 | ||||||||
| Practice Location | |||||||||
| Address1: | 17001 SCIENCE DR | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017317880 | ||||||||
| FaxNumber: | 3017313775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | NAUFUL | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP COMPLIANCE & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 7703092000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 252927 | 01 | MD | MDIPA | OTHER | 7618325 | 01 | MD | AETNA | OTHER | 102822 | 01 | MD | KAISER | OTHER | 4900042 | 01 | MD | CAPITAL COMM HEALTH | OTHER | 8011510 | 01 | MD | CIGNA | OTHER | 85970001 | 01 | VA | CARE FIRST | OTHER | 85TZDI | 01 | MD | CARE FIRST | OTHER | MT35 | 01 | MD | BCBS | OTHER | 071500009 | 05 | MD | MEDICAID | 252927 | 01 | MD | MAMSI | OTHER | 252927 | 01 | MD | ALLIANCE | OTHER | 419630 | 01 | MD | CARE FIRST | OTHER | 520537 | 01 | MD | CARE FIRST | OTHER | 135001 | 01 | MD | ANTHEM BCBS - PIN | OTHER | 85970002 | 01 | VA | CARE FIRST | OTHER | 252927 | 01 | MD | OPTIMUM | OTHER |