Individual provider Active NPI

Alice Nkongtu

  • Psychiatric/Mental Health Nurse Practitioner
  • Silver Spring, MD
National Provider Identifier
1083975619
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R227512 Issued in MD
Practice address
12073 Tech Rd Ste B
Silver Spring, MD 20904-7874
Phone
(301) 593-1315
Fax
(301) 681-4699
NPI assigned
May 30, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R227512 MD Primary
Home Health Aide 374U00000X

Addresses

Primary practice location

12073 Tech Rd Ste B
Silver Spring, MD 20904-7874

Mailing address

12073 Tech Rd Ste B
Silver Spring, MD 20904-7874
Phone (301) 593-1315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240405001280 MD Practitioner - Nurse Practitioner 0941648257 Reassigns benefits to 1 organization
I20240417003651 DC Practitioner - Nurse Practitioner 0941648257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Psychogeriatric Services LLCGroup PAC ID 6002719226, 122 clinicians

Practice addresses (Care Compare)

11215 Oak Leaf Dr
Suite 109
Silver Spring, MD 20901-1300
Phone (301) 593-4222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Psychogeriatric Services LLC CurrentSince Feb 25, 2024 Accepting new patients

Locations

4101 Old National Pike
Mount Airy, MD 21771
Phone (301) 829-0800

12073 Tech Rd
Ste B
Silver Spring, MD 20904
Phone (240) 396-5873

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1083975619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12073 TECH RD STE B",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209047874",
            "telephone_number": "301-593-1315",
            "fax_number": "301-681-4699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12073 TECH RD STE B",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209047874",
            "telephone_number": "301-593-1315",
            "fax_number": "301-681-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NKONGTU",
        "first_name": "ALICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-30",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R227512",
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

Verify at the official NPI Registry.