NPIMap

Organization Active NPI

Prince George's County Health Department

  • Community/Behavioral Health Agency
  • Cheverly, MD
National Provider Identifier
1083945125
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Practice address
3003 Hospital Drive - Ground Floor
Cheverly, MD 20785
Phone
(301) 583-5920
Fax
(301) 583-5953
NPI assigned
Jan 28, 2010
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Tamala Butler
Title
Credentialing Specialist
Phone
(301) 883-7822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

3003 Hospital Drive - Ground Floor
Cheverly, MD 20785

Mailing address

1701 McCormick Dr
Largo, MD 20774-5329
Phone (301) 883-7822

Other identifiers 1

IdentifierTypeStateIssuer
419469100MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170112001236 DC Part B Supplier - Clinic/Group Practice 0547542243 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Capitol Heights, MD; Cheverly, MD; Clinton, MD; Laurel, MD

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Prince George's County Maryland

Practitioners & affiliated clinicians

Practitioners 4

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": "1264636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1083945125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 MCCORMICK DR",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207745329",
            "telephone_number": "301-883-7822",
            "fax_number": "301-883-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HOSPITAL DRIVE - GROUND FLOOR",
            "city": "CHEVERLY",
            "state": "MD",
            "postal_code": "20785",
            "telephone_number": "301-583-5920",
            "fax_number": "301-583-5953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
        "enumeration_date": "2010-01-28",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "TAMALA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "301-883-7822"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "419469100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheverly, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.