NPIMap

Organization Active NPI

Prince Georges County Health Department

  • Public Health or Welfare Agency
  • Cheverly, MD
National Provider Identifier
1124579875
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
PRINCE GEORGES COUNTY HEALTH DEPARTMENT
Practice address
3003 Hospital Dr
Ground Floor
Cheverly, MD 20785-1194
Phone
(301) 583-5920
Fax
(301) 583-5950
NPI assigned
Oct 18, 2016
Organization subpart
Yes
Parent organization
PRINCE GEORGES COUNTY HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Tamala Butler
Title
Credentialing Specialist
Phone
(301) 883-7822

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

3003 Hospital Dr
Ground Floor
Cheverly, MD 20785-1194

Mailing address

3003 Hospital Dr
Ground Floor
Cheverly, MD 20785-1194
Phone (301) 583-5920

Other identifiers 1

IdentifierTypeStateIssuer
10839445125OtherMDOTHER NPI - TYPE 50

Other names 1

  • Northern Region - Outpatient Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170112001236 DC Part B Supplier - Clinic/Group Practice 0547542243 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Capitol Heights, MD; Cheverly, MD; Clinton, MD; Laurel, 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
Part of
Prince Georges County

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": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1124579875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 HOSPITAL DR",
            "address_2": "GROUND FLOOR",
            "city": "CHEVERLY",
            "state": "MD",
            "postal_code": "207851194",
            "telephone_number": "301-583-5920",
            "fax_number": "301-583-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HOSPITAL DR",
            "address_2": "GROUND FLOOR",
            "city": "CHEVERLY",
            "state": "MD",
            "postal_code": "207851194",
            "telephone_number": "301-583-5920",
            "fax_number": "301-583-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE GEORGES COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRINCE GEORGES COUNTY HEALTH DEPARTMENT",
        "enumeration_date": "2016-10-18",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "TAMALA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "301-883-7822"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER NPI - TYPE 50",
            "identifier": "10839445125",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Region - Outpatient",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheverly, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.