Chariss Family Medical Clinic and Med Spa Inc.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

R124903 Issued in MD

Legal business name

CHARISS FAMILY MEDICAL CLINIC AND MED SPA INC.

Practice address

9470 Annapolis Road Suite 401
Lanham, MD 20706

Phone

(240) 770-4315

Fax

(240) 770-4417

NPI assigned

Feb 11, 2014

Last updated

May 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christiana Chinyere Keke-Ekekwe, NPNPI 1811285075

Title

Owner

Phone

(240) 770-4315

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

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.

• Christiana Chinyere Keke-Ekekwe, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lanham, MD
  • NPI 1811285075

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1392076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400803200000",
    "number": "1467876458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9470 ANNAPOLIS RD STE 401",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063025",
            "telephone_number": "240-770-4315",
            "fax_number": "240-770-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9470 ANNAPOLIS ROAD SUITE 401",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "20706",
            "telephone_number": "240-770-4315",
            "fax_number": "240-770-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARISS FAMILY MEDICAL CLINIC AND MED SPA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-11",
        "last_updated": "2014-05-23",
        "status": "A",
        "authorized_official_last_name": "KEKE-EKEKWE",
        "authorized_official_first_name": "CHRISTIANA",
        "authorized_official_middle_name": "CHINYERE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-770-4315",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": "MD",
            "license": "R124903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "448130500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vinodh Chandra
• Karla Rosa Chang, NP
• Agendia Marieclare Chapajong
• Loveline Chapalem, HHA
• Charece House of Beauty
• Chariss Family Medical Clinic and Medical Spa Inc
• Kimberly R Charles, LGSW
• Daniya Dana Chase
• Collins N Che
• Festus Che

• Community Health Worker in Lanham, MD
• Providers in Lanham, MD by specialty
• Community Health Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; 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.