NPIMap

Organization Active NPI

Sheppard Pratt Health System, Inc.

Doing business as Lodge School

  • Adolescent and Children Mental Health Clinic/Center
  • Gaithersburg, MD
National Provider Identifier
1205980885
Registry record updated Jan 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
236 Issued in MD
Legal business name
SHEPPARD PRATT HEALTH SYSTEM, INC.
Doing business as
Lodge School
Practice address
610 E Diamond Ave
Suite E
Gaithersburg, MD 20877-5321
Phone
(301) 208-0561
Fax
(301) 330-0533
NPI assigned
Jan 22, 2007
Last updated
Jan 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2009

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

Authorized official

Name
Ms. Bonnie B Katz
Title
VP Corporate Business Development
Phone
(410) 938-3150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 236 MD Primary

Addresses

Primary practice location

610 E Diamond Ave
Suite E
Gaithersburg, MD 20877-5321

Mailing address

6501 N Charles St
Baltimore, MD 21204-6819
Phone (419) 938-3000

Other identifiers 1

IdentifierTypeStateIssuer
236OtherMDSTATE LICENSE

Other names 1

  • Lodge School Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sheppard Pratt Health System Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Practitioners & affiliated clinicians

Practitioners 1

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232064000000",
    "number": "1205980885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046819",
            "telephone_number": "419-938-3000",
            "fax_number": "410-938-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E DIAMOND AVE",
            "address_2": "SUITE E",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208775321",
            "telephone_number": "301-208-0561",
            "fax_number": "301-330-0533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPPARD PRATT HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2009-01-16",
        "status": "A",
        "authorized_official_last_name": "KATZ",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VP CORPORATE BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "410-938-3150",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MD",
            "license": "236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "236",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodge School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2009; 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.