NPIMap

Organization Active NPI

Cannakush Consulting Office LLC

  • Primary Care Clinic/Center
  • Baltimore, MD
National Provider Identifier
1215528369
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CANNAKUSH CONSULTING OFFICE LLC
Practice address
5411 Old Frederick Rd Ste 18
Baltimore, MD 21229-2126
Phone
(443) 750-0222
NPI assigned
Feb 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Betsy Moore, CRNP
Title
Owner
Phone
(443) 750-0222

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X Primary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

5411 Old Frederick Rd Ste 18
Baltimore, MD 21229-2126

Mailing address

5411 Old Frederick Rd Ste 18
Baltimore, MD 21229-2126
Phone (443) 750-0222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230607000476 MD Part B Supplier - Clinic/Group Practice 6305203308 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Baltimore, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cannakush Consulting Office2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

5411 Old Frederick Rd
Ste 18
Baltimore, MD 21229
Phone (410) 788-4800

Practitioners & affiliated clinicians

Practitioners 4

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": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1215528369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5411 OLD FREDERICK RD STE 18",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212292126",
            "telephone_number": "443-750-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5411 OLD FREDERICK RD STE 18",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212292126",
            "telephone_number": "443-750-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANNAKUSH CONSULTING OFFICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-01",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-750-0222",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.