NPIMap

Organization Active NPI

PHS Medical Specialists Pmb107

  • Infectious Disease Physician
  • Washington, DC
National Provider Identifier
1457693012
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
HFD01-0212 Issued in DC
Legal business name
PHS MEDICAL SPECIALISTS PMB107
Practice address
1140 Varnum St NE
Pmb107
Washington, DC 20017-2151
Phone
(202) 854-4052
Fax
(202) 854-4832
NPI assigned
Mar 21, 2013
Last updated
Sep 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Authorized official

Name
Mr. Charles F Haberkern
Title
VP
Phone
(202) 854-4255

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X HFD01-0212 DC Primary
General Acute Care Hospital 282N00000X HFD01-0212 DC

Addresses

Primary practice location

1140 Varnum St NE
Pmb107
Washington, DC 20017-2151

Mailing address

1160 Varnum St NE
St Catherine's Hall, Room 102
Washington, DC 20017-2107
Phone (202) 854-4069

Other identifiers 3

IdentifierTypeStateIssuer
029833400MedicaidDC
09810714MedicaidVA
005145400MedicaidMD

Other names 1

  • Providence Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
PHS General Surgry Dp31823 organizations share this tax ID, including this one
Part of
PHS General Surgry Dp318

Other organizations with this tax ID 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473120000000",
    "number": "1457693012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 VARNUM ST NE",
            "address_2": "ST CATHERINE'S HALL, ROOM 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 VARNUM ST NE",
            "address_2": "PMB107",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172151",
            "telephone_number": "202-854-4052",
            "fax_number": "202-854-4832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS MEDICAL SPECIALISTS PMB107",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2013-03-21",
        "last_updated": "2016-09-06",
        "status": "A",
        "authorized_official_last_name": "HABERKERN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "202-854-4255",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029833400",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09810714",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005145400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; 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.