NPIMap

Organization Active NPI

Prime Behavioral Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Laurel, MD
National Provider Identifier
1164990818
Registry record updated Nov 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PRIME BEHAVIORAL HEALTH LLC
Practice address
13994 Baltimore Ave Ste 102
Laurel, MD 20707-5087
Phone
(240) 463-3357
NPI assigned
Nov 10, 2018
Last updated
Nov 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2018

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

Authorized official

Name
Dr. Julius FomengiaNPI 1538688684
Title
Partner
Phone
(240) 463-3357

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

13994 Baltimore Ave Ste 102
Laurel, MD 20707-5087

Mailing address

13994 Baltimore Ave Ste 102
Laurel, MD 20707-5087

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20190319000559 DC Part B Supplier - Clinic/Group Practice 7214277839 Receives reassigned benefits from 5 practitioners
Practice locations: Laurel, MD
O20200501000120 MD Part B Supplier - Clinic/Group Practice 7214277839 Receives reassigned benefits from 5 practitioners
Practice locations: Ellicott City, MD
O20260211000740 VA Part B Supplier - Clinic/Group Practice 7214277839 Receives reassigned benefits from 3 practitioners
Practice locations: Laurel, MD

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2167895Prime Behavioral Health LLC13994 Baltimore Avenue Ste 102, Laurel, MD 20707Certificate of waiverJun 17, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1541808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541808000000",
    "number": "1164990818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13994 BALTIMORE AVE STE 102",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13994 BALTIMORE AVE STE 102",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075087",
            "telephone_number": "240-463-3357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-10",
        "last_updated": "2018-11-10",
        "status": "A",
        "authorized_official_last_name": "FOMENGIA",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "240-463-3357",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2018; 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.