Individual provider Active NPI

Ndidi I Harley, DC

  • Chiropractor
  • Crofton, MD
National Provider Identifier
1093011611
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S03843 Issued in MD
Practice address
1641 RT 3 North
Suite 203
Crofton, MD 21114
Phone
(202) 630-4155
NPI assigned
Jan 28, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH030097 DC
Chiropractor 111N00000X 0104556821 VA
Chiropractor 111N00000X S03843 MD Primary

Addresses

Primary practice location

1641 RT 3 North
Suite 203
Crofton, MD 21114

Mailing address

15309 Littleton PL
Upper Marlboro, MD 20774-9053
Phone (202) 630-4155

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200928000180 MD Practitioner - Chiropractic 6103245030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2101 Concord Blvd
Suite E
Crofton, MD 21114-2055
Phone (410) 402-9974

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH030097DCMDChiropractor
S03843MDMDChiropractor
0104556821VAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Heal Chiropractic & Wellness Chiropractor CurrentSince May 19, 2020 Accepting new patients

Locations

1641 State Route 3 N
Ste 203
Crofton, MD 21114
Phone (202) 630-4155

2101 Concord Blvd
Ste E
Crofton, MD 21114
Phone (202) 378-3870

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": "1296172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1093011611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15309 LITTLETON PL",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207749053",
            "telephone_number": "202-630-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 RT 3 NORTH",
            "address_2": "SUITE 203",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "21114",
            "telephone_number": "202-630-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARLEY",
        "first_name": "NDIDI",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "DC",
            "license": "CH030097",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556821",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S03843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crofton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.