NPIMap

Organization Active NPI

RTS Edgewood

  • Methadone Clinic
  • Edgewood, MD
National Provider Identifier
1003368945
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
RTS EDGEWOOD
Practice address
2205 Pulaski Hwy
Edgewood, MD 21040
Phone
(443) 691-5358
NPI assigned
Oct 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Harrison Oliver
Title
Principal
Phone
(443) 691-5358

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

2205 Pulaski Hwy
Edgewood, MD 21040

Mailing address

2205 Pulaski Hwy
Edgewood, MD 21040-1601
Phone (443) 691-5358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Opioid treatment program
Medicare-enrolled since Oct 13, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210308001364 MD Part B Supplier - Opioid Treatment Program (Otp) 5395178826 Practice locations: Edgewood, MD

National Provider Directory

National Provider Directory

Locations

2205 Pulaski Hwy
Edgewood, MD 21040
Phone (443) 456-9001

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1003368945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 PULASKI HWY",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210401601",
            "telephone_number": "443-691-5358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 PULASKI HWY",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "21040",
            "telephone_number": "443-691-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RTS EDGEWOOD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "HARRISON",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "443-691-5358",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.