NPIMap

Organization Active NPI

Brook Lane Health Services

  • Psychiatry Physician
  • Hagerstown, MD
National Provider Identifier
1487862181
Registry record updated Jul 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BROOK LANE HEALTH SERVICES
Practice address
13218 Brooklane Dr
Hagerstown, MD 21742
Phone
(301) 733-0330
Fax
(301) 733-4038
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2018

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

Authorized official

Name
Mrs. Jamie Barkdoll
Title
Coordinator/Managed Care
Phone
(301) 733-0331

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

13218 Brooklane Dr
Hagerstown, MD 21742

Mailing address

13121 Brooklane Dr
Hagerstown, MD 21742-1514
Phone (301) 733-0330

Other identifiers 1

IdentifierTypeStateIssuer
986965400MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040521000256 MD Part B Supplier - Clinic/Group Practice 9436140068 Receives reassigned benefits from 25 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hagerstown, MD; Frederick, MD

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Book Lane House Staff5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532908800000",
    "number": "1487862181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13121 BROOKLANE DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421514",
            "telephone_number": "301-733-0330",
            "fax_number": "301-733-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13218 BROOKLANE DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "21742",
            "telephone_number": "301-733-0330",
            "fax_number": "301-733-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOK LANE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2018-07-30",
        "status": "A",
        "authorized_official_last_name": "BARKDOLL",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "COORDINATOR/MANAGED CARE",
        "authorized_official_telephone_number": "301-733-0331",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "986965400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.

Verify at the official NPI Registry.