Active NPI
Integrated Medical Clinic
- Family Nurse Practitioner
- Lanham, MD
National Provider Identifier
1487289005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- INTEGRATED MEDICAL CLINIC
- Practice address
- 7404 Executive PL Ste 100
Lanham, MD 20706-6237 - Phone
- (240) 758-1782
- NPI assigned
- Mar 4, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paige Smith
- Title
- Practice Adminstrator
- Phone
- (301) 509-4091
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
7404 Executive PL Ste 100
Lanham, MD 20706-6237
Mailing address
7404 Executive PL Ste 100
Lanham, MD 20706-6237
Phone (240) 260-3827
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 4
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": "1583280000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1609113600000",
"number": "1487289005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7404 EXECUTIVE PL STE 100",
"city": "LANHAM",
"state": "MD",
"postal_code": "207066237",
"telephone_number": "240-260-3827",
"fax_number": "240-260-3830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7404 EXECUTIVE PL STE 100",
"city": "LANHAM",
"state": "MD",
"postal_code": "207066237",
"telephone_number": "240-758-1782"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTEGRATED MEDICAL CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2020-03-04",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "PAIGE",
"authorized_official_title_or_position": "PRACTICE ADMINSTRATOR",
"authorized_official_telephone_number": "301-509-4091"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lanham, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.