NPIMap

Organization Active NPI

PHS Multispecialty Services

  • Surgery Physician
  • Washington, DC
National Provider Identifier
1063780674
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
HFD01-0212 Issued in DC
Legal business name
PHS MULTISPECIALTY SERVICES
Practice address
1160 Varnum St NE
Depaul 300
Washington, DC 20017-2107
Phone
(202) 854-4014
Fax
(202) 854-0029
NPI assigned
Dec 9, 2011
Last updated
Sep 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Authorized official

Name
Mr. Charles F Haberkern
Title
VP
Phone
(202) 854-4255

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HFD01-0212 DC
Surgery Physician 208600000X HFD01-0212 DC Primary

Addresses

Primary practice location

1160 Varnum St NE
Depaul 300
Washington, DC 20017-2107

Mailing address

1160 Varnum St NE
St Catherine's Hall, Room 102
Washington, DC 20017-2107
Phone (202) 854-4014

Other identifiers 3

IdentifierTypeStateIssuer
09810714MedicaidVA
005145400MedicaidMD
029833400MedicaidDC

Other names 1

  • Providence Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Emerg Med Providence Ho23 organizations share this tax ID, including this one
Part of
Emerg Med Providence Ho

Other organizations with this tax ID 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473120000000",
    "number": "1063780674",
    "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": "202-854-4014",
            "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 300",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-854-4014",
            "fax_number": "202-854-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS MULTISPECIALTY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2011-12-09",
        "last_updated": "2016-09-06",
        "status": "A",
        "authorized_official_last_name": "HABERKERN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "202-854-4255",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09810714",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005145400",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029833400",
            "state": "DC"
        }
    ],
    "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 Sep 6, 2016; 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.