NPIMap

Organization Active NPI

Medicaid Service, LLC

Doing business as Medicaid Personal Providers

  • Home Health Agency
  • Silver Spring, MD
National Provider Identifier
1417036120
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
R2091 Issued in MD
Legal business name
MEDICAID SERVICE, LLC
Doing business as
Medicaid Personal Providers
Medicaid Personal Providers, LLC
Practice address
8555 16TH St Ste 105
Silver Spring, MD 20910-2802
Phone
(301) 495-6330
Fax
(301) 495-6332
NPI assigned
Nov 3, 2006
Last updated
Jul 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
David Ellwood GreeneNPI 1902226806
Title
Administrator
Phone
(301) 495-6330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X R2091 MD Primary

Addresses

Primary practice location

8555 16TH St Ste 105
Silver Spring, MD 20910-2802

Mailing address

8555 16TH St Ste 105
Silver Spring, MD 20910-2802
Phone (301) 495-6330

Other identifiers 1

IdentifierTypeStateIssuer
474472100MedicaidMD

Other names 2

  • Medicaid Personal Providers Doing business as
  • Medicaid Personal Providers, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medicaid Personal Providers LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

8555 16th St
Ste 105
Silver Spring, MD 20910
Phone (301) 495-6330

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1417036120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8555 16TH ST STE 105",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209102802",
            "telephone_number": "301-495-6330",
            "fax_number": "301-495-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8555 16TH ST STE 105",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209102802",
            "telephone_number": "301-495-6330",
            "fax_number": "301-495-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAID SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ELLWOOD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-495-6330"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MD",
            "license": "R2091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474472100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicaid Personal Providers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicaid Personal Providers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicaid Personal Providers, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.