Luminis Health Medical Group, LLC
Organization Active NPI Psychiatry Physician · Lanham, MD
NPI 1104051440 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1104051440
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- LUMINIS HEALTH MEDICAL GROUP, LLC
- Practice address
- 8200 Good Luck Rd
Lanham, MD 20706-3511 - Phone
- (301) 623-4350
- NPI assigned
- May 15, 2009
- Organization subpart
- No
Authorized official
- Name
- Melissa Rapattoni
- Title
- Ao
- Phone
- (443) 481-5136
Corporate family (same tax ID) 24
Practitioners 8
-
Sharilyn Denise Connally, LGPC
-
Nykenji Nicole Fogg, LCSW-C
-
Andrew P McGlone, MD
-
Ruth Pierre Charles, PA-C
-
Risa Reid, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080707000490 | DC | Part B Supplier - Clinic/Group Practice | 2860447315 |
Receives reassigned benefits from 400 practitioners This NPI is an additional NPI on the enrollment Practice locations: Washington, DC; Upper Marlboro, MD; Temple Hills, MD; Suitland, MD; Riverdale Park, MD; Laurel, MD; Bowie, MD; Largo, MD… |
National Provider Directory
- Tax ID family
- Anne Arundel Phys Group LLC
Locations
201 Defense Hwy
Ste 100
Annapolis, MD 21401
Phone (443) 481-6549
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Child & Adolescent Psychiatric/Mental Health Registered Nurse |
163WP0807X | |||
| Internal Medicine Physician |
207R00000X | |||
| Psychiatry Physician |
2084P0800X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Psychiatric Hospital | 283Q00000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
8200 Good Luck Rd
Lanham, MD 20706-3511
Mailing address
201 Defense Hwy Ste 150
Annapolis, MD 21401-8953
Phone (443) 481-6476
Other practice location 1
8118 Good Luck Rd
Lanham, MD 20706-3574
Phone (443) 481-1000
Other providers in Lanham, MD
- Luminis Health Imaging, Inc.
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
All providers in Lanham, MD · Psychiatry Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.