NPIMap

Organization Active NPI

Indigo Roland Park LLC

  • Physical Therapy Clinic/Center
  • Baltimore, MD
National Provider Identifier
1134866809
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
INDIGO ROLAND PARK LLC
Practice address
600 Wyndhurst Ave Ste 102
Baltimore, MD 21210-2424
Phone
(410) 601-3991
NPI assigned
May 16, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Dr. Samantha Duflo, DPT
Title
Chief Medical Officer
Phone
(410) 279-8231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

600 Wyndhurst Ave Ste 102
Baltimore, MD 21210-2424

Mailing address

600 Wyndhurst Ave Ste 102
Baltimore, MD 21210-2424
Phone (410) 601-3991

Other practice location 1

6020 Meadowridge Center Dr Ste B
Elkridge, MD 21075-7283
Phone (443) 448-3311

Other practice location 2

7735 Tuckerman Ln
Potomac, MD 20854-3266
Phone (667) 777-1293

Other practice location 3

2440 Osprey Way Ste C
Frederick, MD 21701-1958
Phone (240) 223-1722

Other names 1

  • Indigo Physiotherapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240507000170 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3375983430 Receives reassigned benefits from 7 practitioners
Practice locations: Elkridge, MD; Frederick, MD; Baltimore, MD
O20240522000883 DC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3375983430 Receives reassigned benefits from 2 practitioners
Practice locations: Potomac, MD

National Provider Directory

National Provider Directory

Locations

600 Wyndhurst Ave
Ste 102
Baltimore, MD 21210
Phone (410) 601-3991

2440 Osprey Way
Ste C
Frederick, MD 21701
Phone (240) 223-1722

7735 Tuckerman Ln
Potomac, MD 20854
Phone (667) 777-1293

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1134866809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WYNDHURST AVE STE 102",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212102424",
            "telephone_number": "410-601-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WYNDHURST AVE STE 102",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212102424",
            "telephone_number": "410-601-3991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6020 Meadowridge Center Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Elkridge",
            "state": "MD",
            "postal_code": "210757283",
            "country_code": "US",
            "telephone_number": "443-448-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7735 Tuckerman Ln",
            "address_purpose": "LOCATION",
            "city": "Potomac",
            "state": "MD",
            "postal_code": "208543266",
            "country_code": "US",
            "telephone_number": "667-777-1293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2440 Osprey Way Ste C",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217011958",
            "country_code": "US",
            "telephone_number": "240-223-1722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIGO ROLAND PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-16",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "DUFLO",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "410-279-8231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indigo Physiotherapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Indigo Physiotherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; 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.