NPIMap

Individual provider Active NPI

Pamela Denise Brogden, OD

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1245476068
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2129 Issued in MD
Practice address
1253 W Pratt St
Baltimore, MD 21223-2684
Phone
(410) 727-4746
Fax
(410) 727-6767
NPI assigned
Dec 29, 2008
Last updated
Feb 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA2129 MD Primary

Addresses

Primary practice location

1253 W Pratt St
Baltimore, MD 21223-2684

Mailing address

2221 E Bijou St Ste 100
Colorado Springs, CO 80909-8009
Phone (719) 576-1850

Other identifiers 1

IdentifierTypeStateIssuer
0383538-00MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120321000731 MD Practitioner - Optometry 8022278407 Reassigns benefits to 1 organization
I20130114000438 DC Practitioner - Optometry 8022278407 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TA2129MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Barenburg Optical Service, Inc Optometrist CurrentSince Mar 4, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 13, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Optometrist Current Accepting new patients
Michael G Pharris OD PC Optometrist Past Accepting new patients
Ronald B Montano DDS PC Past Accepting new patients

Locations

100 Park Ave
Baltimore, MD 21201
Phone (410) 727-0285

8556 Fort Smallwood Rd
#A
Pasadena, MD 21122
Phone (410) 282-5544

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1245476068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-576-1850",
            "fax_number": "719-955-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 W PRATT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212232684",
            "telephone_number": "410-727-4746",
            "fax_number": "410-727-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGDEN",
        "first_name": "PAMELA",
        "middle_name": "DENISE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-29",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0383538-00",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1253 W Pratt St",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212232684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.