NPIMap

Organization Active NPI

Potomac Pain and Rehabilitation Associates, LLC

  • Physical Medicine & Rehabilitation Physician
  • La Plata, MD
National Provider Identifier
1285850479
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
POTOMAC PAIN AND REHABILITATION ASSOCIATES, LLC
Practice address
203 Centennial St Suite 104
La Plata, MD 20646-2540
Phone
(301) 934-2776
Fax
(301) 934-1417
NPI assigned
Apr 17, 2007
Last updated
Apr 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Authorized official

Name
Fadil Ajay Yunis, M.D.NPI 1245301779
Title
Medical Director
Phone
(301) 934-2776

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
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

203 Centennial St Suite 104
La Plata, MD 20646-2540

Mailing address

PO Box 2540
203 Centennial St Suite 104
La Plata, MD 20646-2540
Phone (301) 934-2776

Other identifiers 1

IdentifierTypeStateIssuer
512006300MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050131000447 MD Part B Supplier - Clinic/Group Practice 3870570419 Receives reassigned benefits from 2 practitioners
Practice locations: La Plata, MD; Prince Frederick, MD

National Provider Directory

National Provider Directory

Locations

1310 Southern Ave SE
#102
Washington, DC 20032
Phone (202) 574-6000

Practitioners & affiliated clinicians

Practitioners 6

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1285850479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2540",
            "address_2": "203 CENTENNIAL ST SUITE 104",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206462540",
            "telephone_number": "301-934-2776",
            "fax_number": "301-934-1417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 CENTENNIAL ST SUITE 104",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206462540",
            "telephone_number": "301-934-2776",
            "fax_number": "301-934-1417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC PAIN AND REHABILITATION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "YUNIS",
        "authorized_official_first_name": "FADIL",
        "authorized_official_middle_name": "AJAY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-934-2776",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "512006300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; 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.