NPIMap

Organization Active NPI

Outreach Recovery II

  • Addiction Medicine (Internal Medicine) Physician
  • Lexington Park, MD
National Provider Identifier
1114614526
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
OUTREACH RECOVERY II
Practice address
21552 Thames Ave Ste 201202
Lexington Park, MD 20653-4009
Phone
(410) 800-4466
NPI assigned
Apr 18, 2023
Last updated
Jul 31, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
OUTREACH RECOVERY IIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Authorized official

Name
Isiah Coles
Title
Coo
Phone
(561) 502-3978

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) Physician 207RA0401X NU Primary

Addresses

Primary practice location

21552 Thames Ave Ste 201202
Lexington Park, MD 20653-4009

Mailing address

14205 Park Center Dr # 201202
Laurel, MD 20707-5246
Phone (410) 800-4466

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210217000254 MD Part B Supplier - Clinic/Group Practice 5294166302 Receives reassigned benefits from 12 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MD; Hagerstown, MD; Lexington Park, MD; Prince Frederick, MD; Waldorf, MD; Frederick, MD; Easton, MD; Glen Burnie, MD…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Outreach Recovery II LLC29 organizations share this tax ID, including this one
Part of
Outreach Recovery II LLC

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

21552 Thames Ave
Ste 201202
Lexington Park, MD 20653

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1114614526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14205 PARK CENTER DR # 201202",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075246",
            "telephone_number": "410-800-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21552 THAMES AVE STE 201202",
            "city": "LEXINGTON PARK",
            "state": "MD",
            "postal_code": "206534009",
            "telephone_number": "410-800-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH RECOVERY II",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUTREACH RECOVERY II",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "COLES",
        "authorized_official_first_name": "ISIAH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "561-502-3978"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.