NPIMap

Organization Active NPI

Comprehensive Healthcare & Wellness Services LLC

  • Primary Care Clinic/Center
  • Upper Marlboro, MD
National Provider Identifier
1366112385
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
COMPREHENSIVE HEALTHCARE & WELLNESS SERVICES LLC
Practice address
1014 Andean Goose Way
Upper Marlboro, MD 20774-7128
Phone
(240) 508-3363
NPI assigned
Sep 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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

Authorized official

Name
Johanese Sandy, CRNPNPI 1154819977
Title
Provider
Phone
(240) 508-3363

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1014 Andean Goose Way
Upper Marlboro, MD 20774-7128

Mailing address

1014 Andean Goose Way
Upper Marlboro, MD 20774-7128
Phone (240) 508-3363

Other identifiers 1

IdentifierTypeStateIssuer
000000MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220321002242 DC Part B Supplier - Clinic/Group Practice 2365837705 Receives reassigned benefits from 1 practitioner
Practice locations: Upper Marlboro, MD

National Provider Directory

National Provider Directory
Tax ID family
Comprehensive Healthcare Wellness Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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": "1632096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1366112385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 ANDEAN GOOSE WAY",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207747128",
            "telephone_number": "240-508-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 ANDEAN GOOSE WAY",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207747128",
            "telephone_number": "240-508-3363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE HEALTHCARE & WELLNESS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-20",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "SANDY",
        "authorized_official_first_name": "JOHANESE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "240-508-3363",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; 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.