NPIMap

Organization Active NPI

PHS Internal Medicine Dp317

  • Internal Medicine Physician
  • Washington, DC
National Provider Identifier
1043474497
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
HFD01-0212 Issued in DC
Legal business name
PHS INTERNAL MEDICINE DP317
Practice address
1160 Varnum St NE
Depaul 317
Washington, DC 20017-2107
Phone
(202) 640-4837
Fax
(202) 636-1138
NPI assigned
Jul 15, 2008
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Authorized official

Name
Beau Higginbotham
Title
Vice President/Coo
Phone
(410) 368-3162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X HFD01-0212 DC Primary

Addresses

Primary practice location

1160 Varnum St NE
Depaul 317
Washington, DC 20017-2107

Mailing address

1160 Varnum St NE
St Catherine'S Hall, Room 102
Washington, DC 20017-2107
Phone (202) 854-4069

Other names 1

  • Providence Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Ft Lincoln Fam Medicine18 organizations share this tax ID, including this one
Part of
PHS Ctr for Geriatric Medicine Dp021

Other organizations with this tax ID 17

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

View all 17

Locations

1160 Varnum St NE
Ste 317
Washington, DC 20017
Phone (202) 529-1961

Practitioners & affiliated clinicians

Practitioners 2

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": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1043474497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 VARNUM ST NE",
            "address_2": "ST CATHERINE'S HALL, ROOM 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 VARNUM ST NE",
            "address_2": "DEPAUL 317",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-640-4837",
            "fax_number": "202-636-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS INTERNAL MEDICINE DP317",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2008-07-15",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "410-368-3162"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; 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.