MD MC Sprout 1 LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

MD MC SPROUT 1 LLC

Doing business as

Elemy
Sprout Therapy

Practice address

7761 Diamondback Rd
College Park, MD 20740-3240

Phone

(301) 265-3520

NPI assigned

Aug 18, 2020

Organization subpart

No

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

Authorized official

Name

Michael Ragheb

Title

Coo

Phone

(786) 210-8200

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1477165868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7761 DIAMONDBACK RD",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207403240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7761 DIAMONDBACK RD",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207403240",
            "telephone_number": "301-265-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MC SPROUT 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-18",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "RAGHEB",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "786-210-8200"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elemy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Behavior Analyst in College Park, MD
• Providers in College Park, MD by specialty
• Behavior Analyst in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; 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.