Tran Mai Phan, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AC004970 Issued in MD

Practice address

11604 Bedford Rd NE Ste 8
Cumberland, MD 21502-6994

Phone

(949) 929-0545

NPI assigned

Jan 30, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Vitality NP Group

  • Nurse Practitioner
  • Baltimore, MD
  • NPI 1912574500
  Medicare reassignment NPD

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1396451704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 WASHINGTON ST",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215022711",
            "telephone_number": "949-929-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11604 BEDFORD RD NE STE 8",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215026994",
            "telephone_number": "949-929-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "TRAN",
        "middle_name": "MAI",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC004970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eileen Peterman, LGPC
• Candice A Peters, MD
• Gregory Peters, CAC-AD
• Kevin Howard Peterson, ED.D.
• Thomas James Pfaff, PHARMD
• Phares Chiropractic LLC (Allegany Chiropractic Center)
• Alexis Phares, FNP
• Charlie Phares, DC
• Ralin Pierce, LCPC
• Todd Preston Pierce, M.D

• Family Nurse Practitioner in Cumberland, MD
• Providers in Cumberland, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.