NPIMap

Organization Active NPI

Lifestream Health Center

  • Clinical Medical Laboratory
  • Bowie, MD
National Provider Identifier
1073059515
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
090266 Issued in MD
Legal business name
LIFESTREAM HEALTH CENTER
Practice address
4000 Mitchellville Rd
Suite B322
Bowie, MD 20716-3104
Phone
(301) 860-0305
Fax
(301) 860-0307
NPI assigned
Jan 9, 2017
Last updated
Jun 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Authorized official

Name
Dr. Sarah A Merritt, M.D.NPI 1730303777
Title
Owner
Phone
(301) 860-0305

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 090266 MD Primary

Addresses

Primary practice location

4000 Mitchellville Rd
Suite B322
Bowie, MD 20716-3104

Mailing address

4000 Mitchellville Rd
Suite B322
Bowie, MD 20716-3104
Phone (301) 860-0305

Other identifiers 1

IdentifierTypeStateIssuer
525405100MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Lifestream Health Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20459/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1073059515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MITCHELLVILLE RD",
            "address_2": "SUITE B322",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207163104",
            "telephone_number": "301-860-0305",
            "fax_number": "301-860-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MITCHELLVILLE RD",
            "address_2": "SUITE B322",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207163104",
            "telephone_number": "301-860-0305",
            "fax_number": "301-860-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "MERRITT",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-860-0305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "090266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "525405100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.