NPIMap

Organization Active NPI

Outreach Recovery II, LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Rockville, MD
National Provider Identifier
1386260990
Registry record updated Jun 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
OUTREACH RECOVERY II, LLC
Practice address
30 W Gude Dr Ste 375
Rockville, MD 20850-4300
Phone
(410) 800-4466
NPI assigned
Jun 19, 2020
Last updated
Jun 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2020

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 Physician 207R00000X NU
Addiction Medicine (Internal Medicine) Physician 207RA0401X NU Primary

Addresses

Primary practice location

30 W Gude Dr Ste 375
Rockville, MD 20850-4300

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
8249491676MedicaidMD

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592524800000",
    "number": "1386260990",
    "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": "30 W GUDE DR STE 375",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504300",
            "telephone_number": "410-800-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH RECOVERY II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "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": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8249491676",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.