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Organization Active NPI

Johns Hopkins University

Doing business as Jhu - Medicine/Geriatrics

  • Geriatric Medicine (Internal Medicine) Physician
  • Baltimore, MD
National Provider Identifier
1104816172
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
JOHNS HOPKINS UNIVERSITY
Doing business as
Jhu - Medicine/Geriatrics
Jhu -Medicine/Geriatrics
Practice address
600 N. Wolfe Street
Baltimore, MD 21264-0001
Phone
(410) 558-5238
NPI assigned
Oct 21, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
JOHNS HOPKINS UNIVERSITYAs reported in NPPES

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

Authorized official

Name
Shavonda L Keating
Title
Sr Production Unit MGR
Phone
(410) 933-6430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X MD Primary

Addresses

Primary practice location

600 N. Wolfe Street
Baltimore, MD 21264-0001

Mailing address

PO Box 64264
Baltimore, MD 21264-4264

Other names 2

  • JHU - MEDICINE/GERIATRICS Doing business as
  • JHU -MEDICINE/GERIATRICS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000719 MD Part B Supplier - Clinic/Group Practice 8921903147 Receives reassigned benefits from 4,764 practitioners
This NPI is an additional NPI on the enrollment
O20130530000068 DC Part B Supplier - Clinic/Group Practice 8921903147 Receives reassigned benefits from 2 practitioners
Practice locations: Washington, DC

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Johns Hopkins Univ

Locations

5505 Hopkins Bayview Cir
Baltimore, MD 21224
Phone (410) 550-0756

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Johns Hopkins Home Health ServicesBaltimore, MD, CCN 217081B Home health agency 5% Or Greater Indirect Ownership Interest (50%) Jun 6, 1990
Johns Hopkins Pediatrics at HomeBaltimore, MD, CCN 217131 Home health agency 5% Or Greater Direct Ownership Interest (30%)
5% Or Greater Indirect Ownership Interest (65%)		 Dec 7, 1992
Dec 7, 1992

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1104816172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64264",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N. WOLFE STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212640001",
            "telephone_number": "410-558-5238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNS HOPKINS UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHNS HOPKINS UNIVERSITY",
        "enumeration_date": "2005-10-21",
        "last_updated": "2022-07-21",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "SHAVONDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR PRODUCTION UNIT MGR",
        "authorized_official_telephone_number": "410-933-6430"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JHU - MEDICINE/GERIATRICS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JHU -MEDICINE/GERIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.