NPIMap

Organization Active NPI

Great Health Medical Group MD PC

  • Primary Care Clinic/Center
  • Lutherville, MD
National Provider Identifier
1407662901
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GREAT HEALTH MEDICAL GROUP MD PC
Practice address
515 Brightfield Rd
Lutherville, MD 21093-3643
Phone
(718) 470-0288
NPI assigned
Dec 9, 2024
Last updated
Jun 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Authorized official

Name
Azlan TariqNPI 1528291283
Title
Owner
Phone
(312) 709-7238

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

515 Brightfield Rd
Lutherville, MD 21093-3643

Mailing address

407 Willoughby Ave
Brooklyn, NY 11205-4590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20250123003457 MD Part B Supplier - Clinic/Group Practice 6002345881 Receives reassigned benefits from 13 practitioners
Practice locations: Lutherville, MD
O20250409000435 DC Part B Supplier - Clinic/Group Practice 6002345881 Receives reassigned benefits from 11 practitioners
Practice locations: Arlington, VA

National Provider Directory

National Provider Directory

Locations

31 Spencer St
Ste 1501
Brooklyn, NY 11205
Phone (718) 854-0001

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1407662901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 WILLOUGHBY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112054590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BRIGHTFIELD RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210933643",
            "telephone_number": "718-470-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT HEALTH MEDICAL GROUP MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "TARIQ",
        "authorized_official_first_name": "AZLAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-709-7238"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.