NPIMap

Organization Active NPI

Prince George'S County Health Department

  • Health Educator
  • Clinton, MD
National Provider Identifier
1366057523
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
Legal business name
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Practice address
9314 Piscataway Rd
Clinton, MD 20735-3630
Phone
(301) 883-7879
NPI assigned
Sep 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Tamala Vicks
Title
Credentialing Specialist
Phone
(301) 883-7822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X Primary

Addresses

Primary practice location

9314 Piscataway Rd
Clinton, MD 20735-3630

Mailing address

1701 McCormick Dr # 120
Largo, MD 20774-5329
Phone (301) 883-7822

Other names 1

  • Prince George's County Health Dept-Diabetes Prev Pgm Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20170112001236 DC Part B Supplier - Clinic/Group Practice 0547542243 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Capitol Heights, MD; Cheverly, MD; Clinton, MD; Laurel, MD
O20240828002349 MD MDPP Supplier - in-Person MDPP Supplier 0547542243 Practice locations: La Plata, MD; Lanham, MD
O20240905001215 DC MDPP Supplier - in-Person MDPP Supplier 0547542243 Practice locations: Capitol Heights, MD; Cheverly, MD; Landover, MD; Largo, MD; Brandywine, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Prince Georges County48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

7450 Albert Rd
Brandywine, MD 20613
Phone (301) 599-0460

9187 Central Ave
Capitol Heights, MD 20743
Phone (240) 521-6489

1701 McCormick Dr
#120
Largo, MD 20774

Practitioners & affiliated clinicians

Practitioners 9

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": "1600041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1366057523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 MCCORMICK DR # 120",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207745329",
            "telephone_number": "301-883-7822",
            "fax_number": "301-883-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9314 PISCATAWAY RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353630",
            "telephone_number": "301-883-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-14",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "VICKS",
        "authorized_official_first_name": "TAMALA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "301-883-7822"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prince George's County Health Dept-Diabetes Prev Pgm",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.