Active NPI
Gorden Fon Kem Bumbara
- Case Manager/Care Coordinator
- Adelphi, MD
National Provider Identifier
1104300102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1906 Fox St
Adelphi, MD 20783-2359 - Phone
- (240) 476-9815
- NPI assigned
- Sep 17, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary | ||
| Home Health Aide | 374U00000X | HHA13955 | DC |
Addresses
Primary practice location
1906 Fox St
Adelphi, MD 20783-2359
Mailing address
1906 Fox St
Adelphi, MD 20783-2359
Phone (240) 476-9815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HHA13955 | DC | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691107200000",
"number": "1104300102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1906 FOX ST",
"city": "ADELPHI",
"state": "MD",
"postal_code": "207832359",
"telephone_number": "240-476-9815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1906 FOX ST",
"city": "ADELPHI",
"state": "MD",
"postal_code": "207832359",
"telephone_number": "240-476-9815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEM BUMBARA",
"first_name": "GORDEN FON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-17",
"last_updated": "2023-08-04",
"certification_date": "2023-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "DC",
"license": "HHA13955",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Adelphi, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.