Village Green Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0061041 Issued in MD

Legal business name

VILLAGE GREEN PRIMARY CARE, LLC

Practice address

1684 Village GRN Lowr Level
Crofton, MD 21114-2059

Phone

(410) 721-3822

Fax

(410) 451-0960

NPI assigned

Nov 6, 2017

Organization subpart

No

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

Authorized official

Name

Allison N Williams, MDNPI 1477545077

Title

Owner Employee

Phone

(410) 721-3822

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Crofton Family Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Allison Nichelle Williams, MD

  • Family Medicine Physician
  • Crofton, MD
  • NPI 1477545077
  Medicare reassignment NPD Authorized official
• Sherri Lynn Dibattista, MA

  • Audiologist-Hearing Aid Fitter
  • Crofton, MD
  • NPI 1285851766
  NPD (past)

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

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1124531702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 VILLAGE GRN LOWR LEVEL",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211142059",
            "telephone_number": "410-721-3822",
            "fax_number": "410-451-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 VILLAGE GRN LOWR LEVEL",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211142059",
            "telephone_number": "410-721-3822",
            "fax_number": "410-451-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE GREEN PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-06",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER EMPLOYEE",
        "authorized_official_telephone_number": "410-721-3822",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0061041",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1455745077",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crofton Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jose Jesus Vega III, LMT
• Madison Velez-Rios
• Venus Counseling
• Julia Ann Lombard Venuti, CRNP
• Vidaluxlook
• Chulaluck Vogel, D.AC., L.AC.
• Natalie Marie Wagstaffe, DDS
• April Anne Wainwright, RN
• Walgreen Co
• Rebekah Wallis

• Family Medicine Physician in Crofton, MD
• Providers in Crofton, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.