NPIMap

Organization Active NPI

Five-Star Integrated Health Services, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Annapolis, MD
National Provider Identifier
1124596606
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
FIVE-STAR INTEGRATED HEALTH SERVICES, LLC
Practice address
1125 West St
Annapolis, MD 21401-3607
Phone
(667) 204-0614
NPI assigned
Nov 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Authorized official

Name
Mrs. Tamia D Rollins-MusgraveNPI 1881962322
Title
Owner
Phone
(443) 534-3652

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0808X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Primary Care Clinic/Center 261QP2300X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1125 West St
Annapolis, MD 21401-3607

Mailing address

1125 West St
Annapolis, MD 21401-3607
Phone (667) 204-0614

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190318001512 MD Part B Supplier - Clinic/Group Practice 6204176878 Receives reassigned benefits from 1 practitioner
Practice locations: Annapolis, MD; Ste 307, MD

National Provider Directory

National Provider Directory
Tax ID family
Five-Star Integrated Health Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1125 West St
Ste 305
Annapolis, MD 21401
Phone (240) 332-0665

1125 West St
Ste 235
Annapolis, MD 21401
Phone (240) 353-1018

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": "1541116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1124596606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 WEST ST",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013607",
            "telephone_number": "667-204-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 WEST ST",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013607",
            "telephone_number": "667-204-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE-STAR INTEGRATED HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-02",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "ROLLINS-MUSGRAVE",
        "authorized_official_first_name": "TAMIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-534-3652",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.