NPIMap

Organization Active NPI

Mosaic Community Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
National Provider Identifier
1124470067
Registry record updated Jul 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
MH-2043 Issued in MD
Legal business name
MOSAIC COMMUNITY SERVICES, INC
Practice address
9201 Philadelphia Rd
Baltimore, MD 21237-4318
Phone
(410) 574-7700
NPI assigned
Jul 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2016

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

Authorized official

Name
Jeff Richardson, CEO
Title
Chief Executive Officer
Phone
(410) 453-9553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X MH-2043 MD Primary

Addresses

Primary practice location

9201 Philadelphia Rd
Baltimore, MD 21237-4318

Mailing address

1925 Greenspring Dr
Timonium, MD 21093-4128
Phone (410) 453-9553

Other identifiers 1

IdentifierTypeStateIssuer
MH2043OtherMDDHMH LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040717000385 MD Part B Supplier - Clinic/Group Practice 0941289417 Receives reassigned benefits from 146 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Frederick, MD; Hagerstown, MD; Rosedale, MD; Timonium, MD; Towson, MD; Westminster, MD

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

1925 Greenspring Dr
Timonium, MD 21093

Practitioners & affiliated clinicians

Practitioners 3

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": "1467504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467504000000",
    "number": "1124470067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 GREENSPRING DR",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210934128",
            "telephone_number": "410-453-9553",
            "fax_number": "443-612-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 PHILADELPHIA RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212374318",
            "telephone_number": "410-574-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC COMMUNITY SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-03",
        "last_updated": "2016-07-03",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "410-453-9553",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "MH-2043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHMH LICENSE",
            "identifier": "MH2043",
            "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 Jul 3, 2016; 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.