NPIMap

Organization Active NPI

Whitman-Walker Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Washington, DC
National Provider Identifier
1184616617
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHITMAN-WALKER CLINIC, INC
Practice address
1525 14TH St NW
Washington, DC 20005-3706
Phone
(202) 745-7000
Fax
(202) 797-3504
NPI assigned
Aug 19, 2005
Organization subpart
Yes
Parent organization
WHITMAN-WALKER CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Mr. Felicia Davis
Title
Credentialing
Phone
(202) 797-4428

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X MD33659 DC
Community Health Clinic/Center 261QC1500X
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

1525 14TH St NW
Washington, DC 20005-3706

Mailing address

1377 R St NW
Washington, DC 20009-6293
Phone (202) 745-7000

Other practice location 1

1377 R St NW
Washington, DC 20009-6293
Phone (202) 745-7000

Other identifiers 4

IdentifierTypeStateIssuer
034298100MedicaidDC
038798600MedicaidDC
038947600MedicaidDC
022385400MedicaidDC

Other names 2

  • Whitman-Walker Health Doing business as
  • Whitman-Walker Health,Inc Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311001525 DC Part B Supplier - Clinic/Group Practice 6507755196 Receives reassigned benefits from 87 practitioners
Practice locations: Arlignton, VA; Hyattsville, MD; Washington, DC
O20140214000712 DC Part A Provider - Federally Qualified Health Center (FQHC) 6507755196 Practice locations: Washington, DC

Federally qualified health center certification: CCN 091849

Legal name
WHITMAN-WALKER CLINIC, INC.
Doing business as
WHITMAN-WALKER HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 3, 2014
Last certification
Feb 3, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 13, 1978 in DC
Enrollment address
1525 14TH Street NW
Washington, DC 20009-3706

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
09D0644945Whitman Walker Clinic Lab1377 R Street, NW Suite 200, Washington, DC 20009Certificate of waiverJun 11, 2028
09D1068514Whitman Walker Clinic Mobile Van #11377 R Street, NW Suite 200, Washington, DC 20009Certificate of waiverMay 13, 2027

National Provider Directory

National Provider Directory
Part of
Whitman Walker Clinic Inc

Locations

1377 R St NW
Washington, DC 20009
Phone (202) 745-7000

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Meghan Davies Individual Corporate OfficerChief of Operations & Program in Jan 1, 2015
Christopher a Holleman Individual Corporate OfficerCheif Financial Officer Apr 6, 2009
Paula M Lantz Individual Corporate DirectorBoard Member Oct 22, 2012
Mark Edward Individual Corporate DirectorBoard Member Feb 27, 2012
Andre Eleazer Individual Corporate OfficerSecretary Aug 23, 2010
Corporate DirectorBoard Member Aug 23, 2010
Donald B Blanchon Individual Corporate OfficerExecutive Director May 1, 2006
Catherine Connolly Individual Corporate DirectorBoard Member Jun 27, 2011
Sean Maher Individual Corporate DirectorBoard Member Feb 23, 2015
Joanna Cifredo Individual Corporate DirectorBoard Member Feb 23, 2015
June Crenshaw Individual Corporate OfficerVice Chair Jan 22, 2007
Corporate DirectorBoard Member Jan 22, 2007
Naseema B Shafi Individual Corporate OfficerDeputy Executive Director Jan 1, 2015
Operational/Managerial ControlCeo Jan 1, 2018
Alison M Gill Individual Corporate DirectorBoard Member Apr 20, 2013
Sandy James Individual Corporate DirectorBoard Member Feb 23, 2015
Stephen Elmendorf Individual Corporate DirectorBoard Member Oct 22, 2012
Ann Bonham Individual Corporate DirectorBoard Member Feb 23, 2015
Cetenia Howard Individual Corporate DirectorBoard Member Feb 23, 2015
Winifred Quinn Individual Corporate DirectorBoard Member Oct 22, 2012
Consuella Lopez Individual Corporate DirectorBoard Member Feb 23, 2015
Thomas H Bullock Individual Corporate DirectorBoard Member Apr 20, 2013
Jehan El-Bayoumi Individual Corporate DirectorBoard Member Feb 22, 2010
Lauren Allen Individual Corporate DirectorBoard Member Feb 23, 2015
Harry Fox Individual Corporate DirectorBoard Member Feb 23, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 90

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

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1184616617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 R ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200096293",
            "telephone_number": "202-745-7000",
            "fax_number": "202-797-3504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 14TH ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200053706",
            "telephone_number": "202-745-7000",
            "fax_number": "202-797-3504"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1377 R St NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200096293",
            "country_code": "US",
            "telephone_number": "202-745-7000",
            "fax_number": "202-797-4412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WHITMAN-WALKER CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITMAN-WALKER CLINIC, INC",
        "enumeration_date": "2005-08-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "FELICIA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "202-797-4428",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "DC",
            "license": "MD33659",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034298100",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038798600",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038947600",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022385400",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitman-Walker Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Whitman-Walker Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Whitman-Walker Health,Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.