NPIMap

Organization Active NPI

Providence Health Services

  • Family Medicine Physician
  • Colmar Manor, MD
National Provider Identifier
1194985515
Registry record updated Oct 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HFD01-0212 Issued in DC
Legal business name
PROVIDENCE HEALTH SERVICES
Practice address
4151 Bladensburg Rd
Colmar Manor, MD 20722-1928
Phone
(301) 699-7700
Fax
(301) 779-9001
NPI assigned
Jun 10, 2008
Last updated
Oct 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2017

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

Authorized official

Name
Timothy Sheridan
Title
Assistant VP, Practice MGT Services
Phone
(202) 269-7374

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X HFD01-0212 DC Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X HFD01-0212 DC

Addresses

Primary practice location

4151 Bladensburg Rd
Colmar Manor, MD 20722-1928

Mailing address

1150 Varnum St NE
Washington, DC 20017-2149
Phone (202) 269-7286

Other identifiers 1

IdentifierTypeStateIssuer
548521501MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
PHS Anesthesia18 organizations share this tax ID, including this one
Part of
Providence Hospital

Other organizations with this tax ID 17

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

View all 17

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIIFBA

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507507200000",
    "number": "1194985515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172149",
            "telephone_number": "202-269-7286",
            "fax_number": "202-269-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 BLADENSBURG RD",
            "city": "COLMAR MANOR",
            "state": "MD",
            "postal_code": "207221928",
            "telephone_number": "301-699-7700",
            "fax_number": "301-779-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2008-06-10",
        "last_updated": "2017-10-09",
        "status": "A",
        "authorized_official_last_name": "SHERIDAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "ASSISTANT VP, PRACTICE MGT SERVICES",
        "authorized_official_telephone_number": "202-269-7374"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "548521501",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colmar Manor, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; 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.