Individual provider Active NPI

Helen Lesada-Lasam Cruz, CRNP

  • Nurse Practitioner
  • Ellicott City, MD
National Provider Identifier
1023061025
Registry record updated Jun 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R070720 Issued in MD
Practice address
2635 Kidwell PL
Ellicott City, MD 21043-4586
Phone
(410) 504-2453
NPI assigned
May 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R070720 MD Primary

Addresses

Primary practice location

2635 Kidwell PL
Ellicott City, MD 21043-4586

Mailing address

2635 Kidwell PL
Ellicott City, MD 21043-4586
Phone (410) 504-2453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130906000662 MD Practitioner - Nurse Practitioner 3274799689 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ennoble HC DMV LLC CurrentSince Jun 20, 2022 Accepting new patients
Maryland Healthcare PC CurrentSince Jun 19, 2017 Accepting new patients
Community Health Center, LLC Past Accepting new patients
Optum Care Services Company Nurse Practitioner Past Accepting new patients

Locations

8115 Maple Lawn Blvd
Ste 350
Fulton, MD 20759
Phone (240) 744-0001

4155 Glen Park Rd
Nottingham, MD 21236
Phone (347) 586-9519

2 University Plz
Ste 204
Hackensack, NJ 07601
Phone (201) 564-0142

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308873600000",
    "number": "1023061025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 KIDWELL PL",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434586",
            "telephone_number": "410-504-2453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 KIDWELL PL",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434586",
            "telephone_number": "410-504-2453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "HELEN",
        "middle_name": "LESADA-LASAM",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2011-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R070720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.