NPIMap

Organization Active NPI

Gemini Health Holdings LLC

  • Addiction (Substance Use Disorder) Psychologist
  • Elkridge, MD
National Provider Identifier
1487280152
Registry record updated Mar 13, 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
6816 Deerpath Rd
Suite 201 and 107
Elkridge, MD 21075
Phone
(301) 703-8767
Fax
(301) 703-8886
NPI assigned
Mar 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Authorized official

Name
Staci Powell, DO
Title
Billing Manager
Phone
(301) 703-8767

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X

Addresses

Primary practice location

6816 Deerpath Rd
Suite 201 and 107
Elkridge, MD 21075

Mailing address

2702 Back Acre Cir Ste 290B
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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1487280152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 BACK ACRE CIR STE 290B",
            "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": "6816 DEERPATH RD",
            "address_2": "SUITE 201 AND 107",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "21075",
            "telephone_number": "301-703-8767",
            "fax_number": "301-703-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEMINI HEALTH HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-13",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "301-703-8767",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.