NPIMap

Organization Active NPI

Gemini Health Holdings LLC

  • Addiction (Substance Use Disorder) Psychologist
  • Mount Airy, MD
National Provider Identifier
1487280087
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
Legal business name
GEMINI HEALTH HOLDINGS LLC
Practice address
1704 Back Acre Cir
Mount Airy, MD 21771-7768
Phone
(301) 703-8767
Fax
(301) 703-8886
NPI assigned
Mar 16, 2020
Last updated
Mar 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Authorized official

Name
Staci Powell, DO
Title
Manager
Phone
(301) 706-8767

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X
Addiction (Substance Use Disorder) Psychologist 103TA0400X Primary
Clinical Psychologist 103TC0700X

Addresses

Primary practice location

1704 Back Acre Cir
Mount Airy, MD 21771-7768

Mailing address

2702 Back Acre Cir Ste 290B2702
Mount Airy, MD 21771-7769
Phone (301) 703-8767

National Provider Directory

National Provider Directory
Tax ID family
Gemini Health Holdings LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

2702 Back Acre Cir
Ste 290B2702
Mount Airy, MD 21771

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1487280087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 BACK ACRE CIR STE 290B2702",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217717769",
            "telephone_number": "301-703-8767",
            "fax_number": "301-703-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 BACK ACRE CIR",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217717768",
            "telephone_number": "301-703-8767",
            "fax_number": "301-703-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEMINI HEALTH HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-706-8767",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Airy, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.