NPIMap

Organization Active NPI

Health Releaf LLC

  • Primary Care Clinic/Center
  • Glen Burnie, MD
National Provider Identifier
1235616475
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
R182264 Issued in MD
Legal business name
HEALTH RELEAF LLC
Practice address
1406B Crain Hwy S Ste 304
Glen Burnie, MD 21061-4094
Phone
(301) 804-0322
Fax
(240) 266-1052
NPI assigned
Jul 20, 2018
Last updated
Dec 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

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

Authorized official

Name
Mrs. Shannon Martin, CRNPNPI 1417322926
Title
Owner
Phone
(240) 671-1747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X R182264 MD Primary

Addresses

Primary practice location

1406B Crain Hwy S Ste 304
Glen Burnie, MD 21061-4094

Mailing address

1406B Crain Hwy S Ste 304
Glen Burnie, MD 21061-4094
Phone (301) 804-0344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181114002271 DC Part B Supplier - Clinic/Group Practice 3971857780 Receives reassigned benefits from 1 practitioner
Practice locations: Bowie, MD
O20181203000131 MD Part B Supplier - Clinic/Group Practice 3971857780 Receives reassigned benefits from 4 practitioners
Practice locations: Glen Burnie, MD

National Provider Directory

National Provider Directory
Tax ID family
Health Releaf LLC2 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

1406B Crain Hwy S
Glen Burnie, MD 21061
Phone (301) 804-0344

Practitioners & affiliated clinicians

Practitioners 7

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": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1235616475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406B CRAIN HWY S STE 304",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614094",
            "telephone_number": "301-804-0344",
            "fax_number": "240-266-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406B CRAIN HWY S STE 304",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614094",
            "telephone_number": "301-804-0322",
            "fax_number": "240-266-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH RELEAF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-20",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-671-1747",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "R182264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; 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.