NPIMap

Organization Active NPI

Pain & Wellness Therapies LLC

  • Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1316413222
Registry record updated Apr 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PAIN & WELLNESS THERAPIES LLC
Practice address
2300 Garrison Blvd Ste 200
Baltimore, MD 21216-2309
Phone
(301) 592-7642
NPI assigned
Oct 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2019

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

Authorized official

Name
Ms. Leslie Ogbebor, AGACNP-BC
Title
Nurse Practitioner
Phone
(301) 592-7642

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X
Physical Therapy Clinic/Center 261QP2000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2300 Garrison Blvd Ste 200
Baltimore, MD 21216-2309

Mailing address

PO Box 688
Jessup, MD 20794-0688

Other identifiers 2

IdentifierTypeStateIssuer
1851637094MedicaidMD
1922502319MedicaidMD

Other names 1

  • Pain & Wellness Therapies Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554854400000",
    "number": "1316413222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 688",
            "city": "JESSUP",
            "state": "MD",
            "postal_code": "207940688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 GARRISON BLVD STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212162309",
            "telephone_number": "301-592-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN & WELLNESS THERAPIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2019-04-10",
        "status": "A",
        "authorized_official_last_name": "OGBEBOR",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "301-592-7642",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "AGACNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851637094",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922502319",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain & Wellness Therapies",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pain & Wellness Therapies",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.