Individual provider Active NPI

Nicholas E Tindong, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lanham, MD
National Provider Identifier
1386637098
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R180878 Issued in MD
Practice address
7404 Executive PL Ste 100
Lanham, MD 20706-6237
Phone
(240) 260-3827
Fax
(240) 260-3830
NPI assigned
Aug 27, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN305565 OH
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R180878 MD Primary

Addresses

Primary practice location

7404 Executive PL Ste 100
Lanham, MD 20706-6237

Mailing address

3613 Celeste Bruce Cir
Bowie, MD 20721-2287
Phone (240) 260-3827

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230525000029 DC Practitioner - Nurse Practitioner 8426414939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Integrated Medical ClinicGroup PAC ID 8921411422, 3 clinicians

Practice addresses (Care Compare)

7404 Executive PL
Suite 100
Lanham, MD 20706-6237
Phone (240) 758-1782

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN305565OHMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Medical Clinic CurrentSince Apr 12, 2023 Accepting new patients

Locations

7404 Executive Pl
Ste 100
Lanham, MD 20706
Phone (240) 260-3827

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1125100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1386637098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 CELESTE BRUCE CIR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207212287",
            "telephone_number": "240-260-3827",
            "fax_number": "240-260-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7404 EXECUTIVE PL STE 100",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207066237",
            "telephone_number": "240-260-3827",
            "fax_number": "240-260-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINDONG",
        "first_name": "NICHOLAS",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-27",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN305565",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R180878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

Verify at the official NPI Registry.