NPIMap

Organization Active NPI

Green Ridge Behavioral Health, LLC

  • Neurology Physician
  • Rockville, MD
National Provider Identifier
1407088339
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
D0056459 Issued in MD
Legal business name
GREEN RIDGE BEHAVIORAL HEALTH, LLC
Practice address
1395 Piccard Dr Ste 320
Rockville, MD 20850-4349
Phone
(240) 683-6202
Fax
(240) 683-6203
NPI assigned
Aug 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
Samina Yousufi, MDNPI 1487608196
Title
Owner
Phone
(240) 683-6202

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X MD
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X D0056459 MD Primary

Addresses

Primary practice location

1395 Piccard Dr Ste 320
Rockville, MD 20850-4349

Mailing address

1395 Piccard Dr Ste 320
Rockville, MD 20850-4349
Phone (240) 683-6202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101130000624 DC Part B Supplier - Clinic/Group Practice 3476685181 Receives reassigned benefits from 12 practitioners
Practice locations: Rockville, MD
O20160204000523 MD Part B Supplier - Clinic/Group Practice 3476685181 Receives reassigned benefits from 1 practitioner
Practice locations: Rockville, MD

National Provider Directory

National Provider Directory

Locations

5216 Chairmans Ct
Ste 102
Frederick, MD 21703
Phone (240) 683-6202

1395 Piccard Dr
Ste 320
Rockville, MD 20850
Phone (240) 683-6202

11120 New Hampshire Ave
Ste 204
Silver Spring, MD 20904
Phone (240) 683-6202

12073 Tech Rd
Ste A
Silver Spring, MD 20904
Phone (240) 683-6202

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1407088339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 PICCARD DR STE 320",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504349",
            "telephone_number": "240-683-6202",
            "fax_number": "240-683-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 PICCARD DR STE 320",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504349",
            "telephone_number": "240-683-6202",
            "fax_number": "240-683-6203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN RIDGE BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-11",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "YOUSUFI",
        "authorized_official_first_name": "SAMINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-683-6202",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MD",
            "license": "D0056459",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 6, 2024; 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.