NPIMap

Organization Active NPI

Outreach Recovery II

  • Addiction Medicine (Internal Medicine) Physician
  • Great Mills, MD
National Provider Identifier
1194308692
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
OUTREACH RECOVERY II
Practice address
22330 Chancellors Run Rd Unit a
Great Mills, MD 20634-2424
Phone
(410) 800-4466
Fax
(410) 705-5024
NPI assigned
May 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2021

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

Authorized official

Name
Isiah Coles, ATC
Title
Coo
Phone
(561) 502-3978

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X Primary

Addresses

Primary practice location

22330 Chancellors Run Rd Unit a
Great Mills, MD 20634-2424

Mailing address

4201 Northview Dr Ste 104
Bowie, MD 20716-2655
Phone (561) 502-3978

Other identifiers 1

IdentifierTypeStateIssuer
20634OtherZIP CODE

National Provider Directory

National Provider Directory
Tax ID family
Outreach Recovery II LLC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

22330 Chancellors Run Rd
Unit A
Great Mills, MD 20634

Practitioners & affiliated clinicians

Practitioners 1

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": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1194308692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 NORTHVIEW DR STE 104",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207162655",
            "telephone_number": "561-502-3978",
            "fax_number": "410-705-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22330 CHANCELLORS RUN RD UNIT A",
            "city": "GREAT MILLS",
            "state": "MD",
            "postal_code": "206342424",
            "telephone_number": "410-800-4466",
            "fax_number": "410-705-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH RECOVERY II",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A",
        "authorized_official_last_name": "COLES",
        "authorized_official_first_name": "ISIAH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "561-502-3978",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ZIP CODE",
            "identifier": "20634",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; 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.