NPIMap

Organization Active NPI

Malama Medical, LLC

  • Addiction Medicine (Preventive Medicine) Physician
  • Baltimore, MD
National Provider Identifier
1023775830
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X
Legal business name
MALAMA MEDICAL, LLC
Practice address
4604 York Rd
Baltimore, MD 21212-4726
Phone
(443) 802-5130
NPI assigned
Nov 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Authorized official

Name
Kimela J Ferguson, CNP
Title
Owner/ Nurse Practitioner
Phone
(443) 802-5130

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083A0300X Primary
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084A0401X
Mental Illness Community Based Residential Treatment Facility 320800000X
Psychiatric Residential Treatment Facility 323P00000X
Substance Abuse Rehabilitation Facility 324500000X
Children's Substance Abuse Rehabilitation Facility 3245S0500X

Addresses

Primary practice location

4604 York Rd
Baltimore, MD 21212-4726

Mailing address

4604 York Rd
Baltimore, MD 21212-4726
Phone (443) 902-8017

National Provider Directory

National Provider Directory
Tax ID family
Malama Medical4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4604 York Rd
Baltimore, MD 21212
Phone (443) 802-5130

NPI Registry JSON

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1023775830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4604 YORK RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212124726",
            "telephone_number": "443-902-8017",
            "fax_number": "443-201-7037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4604 YORK RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212124726",
            "telephone_number": "443-802-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALAMA MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-29",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "KIMELA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/ NURSE PRACTITIONER",
        "authorized_official_telephone_number": "443-802-5130",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.