Active NPI
Black Rock Integrative Medicine
- Multi-Specialty Clinic/Center
- Hagerstown, MD
National Provider Identifier
1285102764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- BLACK ROCK INTEGRATIVE MEDICINE
- Practice address
- 120 N Potomac St
Hagerstown, MD 21740-4810 - Phone
- (301) 790-4938
- Fax
- (301) 850-2135
- NPI assigned
- Nov 2, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Sheri Denham, CRNP
- Title
- Nurse Practitioner/ Owner
- Phone
- (301) 790-4938
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
120 N Potomac St
Hagerstown, MD 21740-4810
Mailing address
20615 Woodbridge Dr
Hagerstown, MD 21742-3188
Phone (301) 790-4938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220803000141 | MD | Part B Supplier - Clinic/Group Practice | 1052793312 |
Receives reassigned benefits from 8 practitioners Practice locations: Hagerstown, MD |
National Provider Directory
National Provider Directory- Tax ID family
- Black Rock Integrative Medicine
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Hagerstown, MD
- NPI 1285247817
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Frederick, MD
- NPI 1538095591
-
- Multi-Specialty Clinic/Center
- Frederick, MD
- NPI 1770418444
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Hagerstown, MD
- NPI 1710720875
MD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541116800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1720396800000",
"number": "1285102764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20615 WOODBRIDGE DR",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217423188",
"telephone_number": "301-790-4938",
"fax_number": "301-850-2135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 N POTOMAC ST",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217404810",
"telephone_number": "301-790-4938",
"fax_number": "301-850-2135"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLACK ROCK INTEGRATIVE MEDICINE",
"organizational_subpart": "NO",
"enumeration_date": "2018-11-02",
"last_updated": "2024-07-08",
"certification_date": "2024-07-08",
"status": "A",
"authorized_official_last_name": "DENHAM",
"authorized_official_first_name": "SHERI",
"authorized_official_title_or_position": "NURSE PRACTITIONER/ OWNER",
"authorized_official_telephone_number": "301-790-4938",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "CRNP"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.