NPIMap

Organization Active NPI

Hormones & Immunology Personalized Medicine

  • Nurse Practitioner
  • Reisterstown, MD
National Provider Identifier
1033821830
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
HORMONES & IMMUNOLOGY PERSONALIZED MEDICINE
Practice address
100 Owings CT Ste 12
Reisterstown, MD 21136-6434
Phone
(443) 204-1134
NPI assigned
Dec 23, 2022
Organization subpart
Yes
Parent organization
HORMONES & IMMUNOLOGY PERSONALIZED MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Authorized official

Name
Lavon Magruder, CRNPNPI 1124765680
Title
Owner
Phone
(443) 204-1134

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

100 Owings CT Ste 12
Reisterstown, MD 21136-6434

Mailing address

9954 Shoshone Way
Randallstown, MD 21133-1739
Phone (443) 204-1134

Other names 1

  • H&I Personalized Medicine Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL EMR Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315000404 MD Part B Supplier - Clinic/Group Practice 3072987015 Receives reassigned benefits from 1 practitioner
Practice locations: Reisterstown, MD

National Provider Directory

National Provider Directory
Tax ID family
Hormones Immunology PR Med2 organizations share this tax ID, including this one
Part of
Hormones Immunology PR Med

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1671753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1033821830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9954 SHOSHONE WAY",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211331739",
            "telephone_number": "443-204-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 OWINGS CT STE 12",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211366434",
            "telephone_number": "443-204-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORMONES & IMMUNOLOGY PERSONALIZED MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HORMONES & IMMUNOLOGY PERSONALIZED MEDICINE",
        "enumeration_date": "2022-12-23",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "MAGRUDER",
        "authorized_official_first_name": "LAVON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-204-1134",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "endpointDescription": "EMR patient/provider portal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Owings Ct Ste 12",
            "city": "Reisterstown",
            "state": "MD",
            "country_code": "US",
            "postal_code": "211366434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "H&I Personalized Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "H&I Personalized Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reisterstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; 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.