Peridot Primary Care, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PERIDOT PRIMARY CARE, LLC

Practice address

23202 Brewers Tavern Way
Clarksburg, MD 20871-4391

Phone

(301) 215-2309

Fax

(855) 942-3275

NPI assigned

Sep 17, 2020

Organization subpart

No

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

Authorized official

Name

Princess StephensonNPI 1881155901

Title

Managing Member

Phone

(301) 298-9919

Specialties & licenses 1

Addresses

Other names 1

• True Vitality Consulting, LLC Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Princess Stephenson, APRN, FNP-C

  • Family Nurse Practitioner
  • Clarksburg, MD
  • NPI 1881155901
  Authorized official Same address or phone
• Geraldine Gan, DNP

  • Family Nurse Practitioner
  • Frederick, MD
  • NPI 1124780523
  NPD
• Saba Afzal Warraich, NP

  • Family Nurse Practitioner
  • Frederick, MD
  • NPI 1336807874
  NPD

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1356957252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23202 BREWERS TAVERN WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714391",
            "telephone_number": "301-298-9919",
            "fax_number": "301-298-9917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23202 BREWERS TAVERN WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714391",
            "telephone_number": "301-215-2309",
            "fax_number": "855-942-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIDOT PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "PRINCESS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "301-298-9919"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "True Vitality Consulting, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Paines Rosenberg Therapy, P.C.
• Lauren Elizabeth Palmer, CPNP
• Milankumar Maheshbhai Patel, PT
• Jeremy Pearson
• Hannelyn Perez
• Briona M Phillips, PHD, MPH, MSW
• Physical Therapy and Wellness by Design LLC
• Jasmine Pollard, RN, MSN, CCM
• Emily Cartwright Poole, RD, LDN
• Praveen Bolarum, MD LLC

• Family Nurse Practitioner in Clarksburg, MD
• Providers in Clarksburg, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.