NPIMap

Organization Active NPI

Sovereignty Health Services LLC

  • Occupational Therapist
  • Edgewood, MD
National Provider Identifier
1487288635
Registry record updated Mar 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
SOVEREIGNTY HEALTH SERVICES LLC
Practice address
1319 Woodbridge Station Way Unit 102
Edgewood, MD 21040-3852
Phone
(410) 940-1983
NPI assigned
Feb 26, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2020

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

Authorized official

Name
Kehinde M Tijani, OTR/L
Title
Occupational Therapist
Phone
(410) 940-1983

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

1319 Woodbridge Station Way Unit 102
Edgewood, MD 21040-3852

Mailing address

152 Spectator LN
Owings Mills, MD 21117-4444
Phone (410) 940-1983

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL WEBPT Direct

National Provider Directory

National Provider Directory

Locations

1319 Woodbridge Station Way
Unit 102
Edgewood, MD 21040
Phone (410) 940-1983

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": "1582675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583539200000",
    "number": "1487288635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 SPECTATOR LN",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174444",
            "telephone_number": "410-940-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 WOODBRIDGE STATION WAY UNIT 102",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210403852",
            "telephone_number": "410-940-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGNTY HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-26",
        "last_updated": "2020-03-07",
        "certification_date": "2020-03-07",
        "status": "A",
        "authorized_official_last_name": "TIJANI",
        "authorized_official_first_name": "KEHINDE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "410-940-1983",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WEBPT",
            "affiliation": "N",
            "endpointDescription": "Documentation of pts' evaluation, assessment, treatments, progress including billing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Documentation of pt's assessment and treatments related to diagnosis and prognosis  in conjunction with physicians' orders",
            "address_1": "1319 Woodbridge Station Way Unit 102",
            "city": "Edgewood",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210403852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edgewood, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.