NPIMap

Organization Active NPI

Passport Health Holdings, LLC

  • Community Health Worker
  • Bethesada, MD
National Provider Identifier
1124827118
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
PASSPORT HEALTH HOLDINGS, LLC
Practice address
10401 Old Georgetown Road
Suite 202
Bethesada, MD 20814
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
Mar 11, 2025
Last updated
Mar 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Juana Slack
Title
Medical Billing Specialist
Phone
(480) 646-9086

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 172V00000X Primary

Addresses

Primary practice location

10401 Old Georgetown Road
Suite 202
Bethesada, MD 20814

Mailing address

4343 East Outlier Blvd.
Suite 100W
Phoenix, AZ 85008-6507
Phone (877) 358-8648

National Provider Directory

National Provider Directory
Tax ID family
Passport Health Holdings LLC219 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

10401 Old Georgetown Rd
Ste 202
Bethesda, MD 20814

NPI Registry JSON

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

{
    "created_epoch": "1741651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1124827118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 EAST OUTLIER BLVD.",
            "address_2": "SUITE 100W",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086507",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10401 OLD GEORGETOWN ROAD",
            "address_2": "SUITE 202",
            "city": "BETHESADA",
            "state": "MD",
            "postal_code": "20814",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-11",
        "last_updated": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "JUANA",
        "authorized_official_title_or_position": "MEDICAL BILLING SPECIALIST",
        "authorized_official_telephone_number": "480-646-9086"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.