Individual provider Active NPI

Eugene Cuevas Diokno, MD

  • Pediatrics Physician
  • Baltimore, MD
National Provider Identifier
1407840424
Registry record updated Mar 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0053961 Issued in MD
Practice address
1501 Division St
Baltimore, MD 21217-3121
Phone
(410) 383-8300
Fax
(410) 383-3160
NPI assigned
Sep 6, 2005
Last updated
Mar 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Sports Medicine Physician 2080S0010X D0053961 MD
Pediatrics Physician 208000000X D0053961 MD Primary

Addresses

Primary practice location

1501 Division St
Baltimore, MD 21217-3121

Mailing address

143 Versailles Cir Apt C
Towson, MD 21204-6932
Phone (240) 675-0204

Other identifiers 1

IdentifierTypeStateIssuer
441102100MedicaidMD

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071130000364 MD Practitioner - Pediatric MedicinePractitioner - Other (Physician) 5991894859 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0053961MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Total Health Care Inc. CurrentSince Mar 10, 2018 Accepting new patients
Total Health Care Inc CurrentSince Mar 10, 2018 Accepting new patients
Total Health Care Inc Current Accepting new patients
Union Memorial Hospital Past Accepting new patients
Medlantic Healthcare Group Past Accepting new patients

Locations

1111 Washington Blvd
Baltimore, MD 21230
Phone 4103838300 ext. 10901

1501 Division St
Baltimore, MD 21217
Phone (410) 735-5390

2401 Liberty Heights Ave
Baltimore, MD 21215
Phone (410) 233-1088

1501 W Saratoga St
Baltimore, MD 21223
Phone (410) 383-7197

2288 Blue Water Blvd
Ste 440
Odenton, MD 21113
Phone (410) 674-7403

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GJFJBD

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1407840424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 VERSAILLES CIR APT C",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046932",
            "telephone_number": "240-675-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 DIVISION ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212173121",
            "telephone_number": "410-383-8300",
            "fax_number": "410-383-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIOKNO",
        "first_name": "EUGENE",
        "middle_name": "CUEVAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080S0010X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sports Medicine",
            "state": "MD",
            "license": "D0053961",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0053961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "441102100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.