Port Recovery Physicians Care LLC
Organization Active NPI Internal Medicine Physician · Nottingham, MD
NPI 1124470356 · NPPES record last updated May 30, 2025
Key facts
- NPI
- 1124470356
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- PORT RECOVERY PHYSICIANS CARE LLC
- Practice address
- 8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028 - Phone
- (443) 869-4909
- Fax
- (443) 869-4928
- NPI assigned
- Jul 12, 2016
- Organization subpart
- No
Authorized official
- Name
- Joanne Granruth
- Title
- Owner
- Phone
- (410) 534-8735
Practitioners 3
-
Elaine Malvina Cook, CRNP
-
Randal A Steele, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161121000298 | MD | Part B Supplier - Clinic/Group Practice | 8123307865 |
Receives reassigned benefits from 3 practitioners Practice locations: Nottingham, MD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Mailing address
8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Phone (443) 534-8735
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 886200100 | Medicaid | MD | |
| CP64-0000 | Other | MD | CAREFIRST BLUECROSS BLUESHEILD |
Other providers in Nottingham, MD
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Mental Health, Inc.
- Port Recovery, Inc.
- Kelley Porter
- Lekh Poudel
- Tina Powell
- Manish Prajapati
All providers in Nottingham, MD · Internal Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.