Active NPI
Ade Elehanah Tayim
- Case Manager/Care Coordinator
- Upper Marlboro, MD
National Provider Identifier
1477078186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1203 Redcrested CT
Upper Marlboro, MD 20774-7081 - Phone
- (301) 683-4579
- NPI assigned
- Aug 3, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | HHA12952 | WA | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
1203 Redcrested CT
Upper Marlboro, MD 20774-7081
Mailing address
1203 Redcrested CT
Upper Marlboro, MD 20774-7081
Phone (301) 683-4579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HHA12952 | WA | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1477078186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 REDCRESTED CT",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207747081",
"telephone_number": "301-683-4579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 REDCRESTED CT",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207747081",
"telephone_number": "301-683-4579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYIM",
"first_name": "ADE",
"middle_name": "ELEHANAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-03",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "WA",
"license": "HHA12952",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.