NPIMap

Organization Active NPI

Maryland Group Faculty Practice LLC

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1104036300
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MARYLAND GROUP FACULTY PRACTICE LLC
Practice address
419 W Redwood St
Suite 570
Baltimore, MD 21201-1734
Phone
(410) 328-6106
Fax
(410) 328-1130
NPI assigned
May 23, 2007
Last updated
Oct 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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

Authorized official

Name
Michele James
Title
Office Manager
Phone
(410) 598-8700

Specialties & licenses 1

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

Addresses

Primary practice location

419 W Redwood St
Suite 570
Baltimore, MD 21201-1734

Mailing address

419 W Redwood St
Suite 570
Baltimore, MD 21201-1734
Phone (410) 328-6106

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226001095 MD Part B Supplier - Clinic/Group Practice 5799671533 Receives reassigned benefits from 9 practitioners
Practice locations: Ellicott City, MD; Baltimore, MD

National Provider Directory

National Provider Directory

Locations

1500 Sulgrave Ave
Baltimore, MD 21209
Phone (410) 328-1128

2 Hamill Rd
Ste 353
Baltimore, MD 21210
Phone (410) 323-0082

419 W Redwood St
Ste 570
Baltimore, MD 21201
Phone (410) 328-6106

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1104036300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 W REDWOOD ST",
            "address_2": "SUITE 570",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011734",
            "telephone_number": "410-328-6106",
            "fax_number": "410-328-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 W REDWOOD ST",
            "address_2": "SUITE 570",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011734",
            "telephone_number": "410-328-6106",
            "fax_number": "410-328-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND GROUP FACULTY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "410-598-8700"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.