Organization Active NPI

Change Health Systems, Inc.

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1124308002
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MH-825 Issued in MD
Legal business name
CHANGE HEALTH SYSTEMS, INC.
Practice address
2401 Liberty Heights Ave
Suite 4670
Baltimore, MD 21215-8019
Phone
(410) 233-1088
Fax
(410) 233-1087
NPI assigned
Aug 23, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Authorized official

Name
Mr. Israel Ojo
Title
Ceo
Phone
(410) 233-1088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MH-825 MD Primary

Addresses

Primary practice location

2401 Liberty Heights Ave
Suite 4670
Baltimore, MD 21215-8019

Mailing address

2401 Liberty Heights Ave
Suite 4670
Baltimore, MD 21215-8019
Phone (410) 233-1088

Other identifiers 1

IdentifierTypeStateIssuer
400314400MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090317000486 MD Part B Supplier - Clinic/Group Practice 9335206465 Receives reassigned benefits from 10 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Hagerstown, MD

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685491200000",
    "number": "1124308002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 LIBERTY HEIGHTS AVE",
            "address_2": "SUITE 4670",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212158019",
            "telephone_number": "410-233-1088",
            "fax_number": "410-233-1087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 LIBERTY HEIGHTS AVE",
            "address_2": "SUITE 4670",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212158019",
            "telephone_number": "410-233-1088",
            "fax_number": "410-233-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE HEALTH SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-23",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A",
        "authorized_official_last_name": "OJO",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-233-1088",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "MH-825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400314400",
            "state": "MD"
        }
    ],
    "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 May 31, 2023; 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.