NPIMap

Organization Active NPI

PHS Behavioral Medicine

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Washington, DC
National Provider Identifier
1396012837
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X
License
HFD01-0212 Issued in DC
Legal business name
PHS BEHAVIORAL MEDICINE
Practice address
1053 Buchanan St NE
Suite 055
Washington, DC 20017-2712
Phone
(202) 269-7626
Fax
(202) 269-7616
NPI assigned
Nov 29, 2011
Last updated
Sep 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Authorized official

Name
Mr. Charles F Haberkern
Title
VP
Phone
(202) 854-4255

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HFD01-0112 DC
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X HFD01-0212 DC Primary
Neurology Physician 2084N0400X HFD01-0212 DC

Addresses

Primary practice location

1053 Buchanan St NE
Suite 055
Washington, DC 20017-2712

Mailing address

1150 Varnum St NE
St Catherine's Hall, Room 102
Washington, DC 20017-2104
Phone (202) 854-4069

Other identifiers 3

IdentifierTypeStateIssuer
029833400MedicaidDC
09810714MedicaidVA
005145400MedicaidMD

Other names 1

  • Providence Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Providence Hospital23 organizations share this tax ID, including this one
Part of
Providence Hospital

Other organizations with this tax ID 22

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

View all 22

Locations

1053 Buchanan St NE
Ste 55
Washington, DC 20017
Phone (202) 269-7626

NPI Registry JSON

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

{
    "created_epoch": "1322524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473120000000",
    "number": "1396012837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST CATHERINE'S HALL, ROOM 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 BUCHANAN ST NE",
            "address_2": "SUITE 055",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172712",
            "telephone_number": "202-269-7626",
            "fax_number": "202-269-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS BEHAVIORAL MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2011-11-29",
        "last_updated": "2016-09-06",
        "status": "A",
        "authorized_official_last_name": "HABERKERN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "202-854-4255",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "DC",
            "license": "HFD01-0112",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029833400",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09810714",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005145400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; 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.