Individual provider Active NPI

Ade Elehanah Tayim

  • Case Manager/Care Coordinator
  • Upper Marlboro, MD
National Provider Identifier
1477078186
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
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

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
HHA12952WAMDHome 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.

Verify at the official NPI Registry.