NPIMap

Organization Active NPI

Nexus Wellness Group

  • Clinical Social Worker
  • Owings Mills, MD
National Provider Identifier
1033877386
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
NEXUS WELLNESS GROUP
Practice address
10220 S Dolfield Rd Ste 204
Owings Mills, MD 21117-3624
NPI assigned
Dec 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Authorized official

Name
Ebony S Vaughan, LCSW-C
Title
Owner
Phone
(410) 382-4536

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

10220 S Dolfield Rd Ste 204
Owings Mills, MD 21117-3624

Mailing address

10220 S Dolfield Rd Ste 204
Owings Mills, MD 21117-3624
Phone (410) 382-4536

Other identifiers 1

IdentifierTypeStateIssuer
1871760397MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220525001162 MD Part B Supplier - Clinic/Group Practice 3678951068 Receives reassigned benefits from 3 practitioners
Practice locations: Owings Mills, MD

National Provider Directory

National Provider Directory
Tax ID family
Nexus Wellness Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

10220 S Dolfield Rd
Ste 204
Owings Mills, MD 21117
Phone (410) 382-4536

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638489600000",
    "number": "1033877386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10220 S DOLFIELD RD STE 204",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173624",
            "telephone_number": "410-382-4536",
            "fax_number": "410-655-1329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10220 S DOLFIELD RD STE 204",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEXUS WELLNESS GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "EBONY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-382-4536",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871760397",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; 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.