NPIMap

Organization Active NPI

Outreach Recovery II

  • Addiction Medicine (Internal Medicine) Physician
  • Baltimore, MD
National Provider Identifier
1346825486
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
OUTREACH RECOVERY II
Practice address
222 N Charles St Ste 101B
Baltimore, MD 21201-4032
Phone
(410) 800-4466
NPI assigned
Mar 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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

Authorized official

Name
Isiah Coles
Title
Coo
Phone
(561) 502-3978

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X Primary

Addresses

Primary practice location

222 N Charles St Ste 101B
Baltimore, MD 21201-4032

Mailing address

4201 Northview Dr Ste 104
Bowie, MD 20716-2655
Phone (410) 800-4466

Other identifiers 1

IdentifierTypeStateIssuer
100170888MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210217000254 MD Part B Supplier - Clinic/Group Practice 5294166302 Receives reassigned benefits from 12 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MD; Hagerstown, MD; Lexington Park, MD; Prince Frederick, MD; Waldorf, MD; Frederick, MD; Easton, MD; Glen Burnie, MD…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Outreach Recovery II LLC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1346825486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 NORTHVIEW DR STE 104",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207162655",
            "telephone_number": "410-800-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N CHARLES ST STE 101B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212014032",
            "telephone_number": "410-800-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH RECOVERY II",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "COLES",
        "authorized_official_first_name": "ISIAH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "561-502-3978"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100170888",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 10, 2021; 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.