NPIMap

Organization Active NPI

La Clinica del Pueblo

  • Clinic/Center
  • Washington, DC
National Provider Identifier
1215485396
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
52194XXXX650001047 Issued in DC
Legal business name
LA CLINICA DEL PUEBLO
Practice address
3166 Mount Pleasant St NW
Washington, DC 20010
Phone
(202) 462-4788
Fax
(202) 667-3706
NPI assigned
Sep 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Joanie Clement Rodrick
Title
Chief Financial Officer
Phone
(202) 464-0141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 52194XXXX650001047 DC Primary

Addresses

Primary practice location

3166 Mount Pleasant St NW
Washington, DC 20010

Mailing address

2831 15TH Street NW
Washington, DC 20009
Phone (202) 462-4788

Other identifiers 1

IdentifierTypeStateIssuer
85518500MedicaidDC

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Pueblo5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

3055 Mount Pleasant St NW
Washington, DC 20009

3166 Mount Pleasant St NW
Washington, DC 20010
Phone (202) 462-4788

NPI Registry JSON

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

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1215485396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2831 15TH STREET NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20009",
            "telephone_number": "202-462-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3166 MOUNT PLEASANT ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20010",
            "telephone_number": "202-462-4788",
            "fax_number": "202-667-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DEL PUEBLO",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-16",
        "last_updated": "2021-09-23",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "RODRICK",
        "authorized_official_first_name": "JOANIE",
        "authorized_official_middle_name": "CLEMENT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "202-464-0141"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "DC",
            "license": "52194XXXX650001047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85518500",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.