NPIMap

Organization Active NPI

White Marsh Psychiatric Associates, LLC

  • Psychiatry Physician
  • Baltimore, MD
National Provider Identifier
1043466147
Registry record updated Sep 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WHITE MARSH PSYCHIATRIC ASSOCIATES, LLC
Practice address
5024 Campbell Blvd
Suite H
Baltimore, MD 21236-5974
Phone
(410) 931-6694
NPI assigned
Aug 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2008

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

Authorized official

Name
Mrs. Dianne C Denton
Title
Practice Manager
Phone
(410) 931-9280

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

5024 Campbell Blvd
Suite H
Baltimore, MD 21236-5974

Mailing address

5024 Campbell Blvd
Suite H
Baltimore, MD 21236-5974
Phone (410) 931-6694

Other identifiers 2

IdentifierTypeStateIssuer
187200500MedicaidMD
15410050MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081002000513 MD Part B Supplier - Clinic/Group Practice 3072681105 Receives reassigned benefits from 12 practitioners
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1218153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221696000000",
    "number": "1043466147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5024 CAMPBELL BLVD",
            "address_2": "SUITE H",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365974",
            "telephone_number": "410-931-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 CAMPBELL BLVD",
            "address_2": "SUITE H",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365974",
            "telephone_number": "410-931-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MARSH PSYCHIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-08",
        "last_updated": "2008-09-18",
        "status": "A",
        "authorized_official_last_name": "DENTON",
        "authorized_official_first_name": "DIANNE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "410-931-9280",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187200500",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15410050",
            "state": "MD"
        }
    ],
    "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 Sep 18, 2008; 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.