NPIMap

Organization Active NPI

Providence Health Services, Inc

Doing business as PHS Cardiology

  • Cardiovascular Disease Physician
  • Washington, DC
National Provider Identifier
1356859334
Registry record updated Jan 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
HFD01-0212 Issued in DC
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Doing business as
PHS Cardiology
Practice address
1150 Varnum St NE Ste 300
Washington, DC 20017-2180
Phone
(202) 854-4830
Fax
(202) 854-4836
NPI assigned
Jan 12, 2018
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2018

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

Authorized official

Name
Beau Higginbothan
Title
Vice President/Coo
Phone
(410) 368-3182

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X HFD01-0212 DC
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X HFD01-0212 DC Primary

Addresses

Primary practice location

1150 Varnum St NE Ste 300
Washington, DC 20017-2180

Mailing address

1150 Varnum St NE
St Catherines Hall, Room 102
Washington, DC 20017-2104
Phone (202) 854-4069

Other names 1

  • PHS Cardiology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ft Lincoln Fam Medicine18 organizations share this tax ID, including this one
Part of
PHS Ctr for Geriatric Medicine Dp021

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 2

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": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515715200000",
    "number": "1356859334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST CATHERINES HALL, ROOM 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE STE 300",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172180",
            "telephone_number": "202-854-4830",
            "fax_number": "202-854-4836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2018-01-12",
        "last_updated": "2018-01-12",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "410-368-3182"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2018; 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.