NPIMap

Organization Active NPI

Pikesville Health Services LLC

  • Methadone Clinic
  • Baltimore, MD
National Provider Identifier
1497102867
Registry record updated Aug 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
906136 Issued in MD
Legal business name
PIKESVILLE HEALTH SERVICES LLC
Practice address
1209 Greenwood Rd
Baltimore, MD 21208
Phone
(410) 415-6384
NPI assigned
May 16, 2016
Last updated
Aug 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2016

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

Authorized official

Name
Amiel Chicheportiche, BS
Title
Program Sponsor
Phone
(410) 415-6384

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 906136 MD Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 906136 MD

Addresses

Primary practice location

1209 Greenwood Rd
Baltimore, MD 21208

Mailing address

2833 Smithe Ave
Suite # 148
Baltimore, MD 21209
Phone (410) 415-6384

Other identifiers 2

IdentifierTypeStateIssuer
2000351MedicaidMD
899655OtherMDBEACON

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200102001909 MD Part B Supplier - Opioid Treatment Program (Otp) 4880989938 Practice locations: Pikesville, MD
O20220107000785 MD Part B Supplier - Mass Immunization (Roster Biller Only) 4880989938 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

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, 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": "1463356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471478400000",
    "number": "1497102867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2833 SMITHE AVE",
            "address_2": "SUITE # 148",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21209",
            "telephone_number": "410-415-6384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 GREENWOOD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21208",
            "telephone_number": "410-415-6384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIKESVILLE HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-16",
        "last_updated": "2016-08-18",
        "status": "A",
        "authorized_official_last_name": "CHICHEPORTICHE",
        "authorized_official_first_name": "AMIEL",
        "authorized_official_title_or_position": "PROGRAM SPONSOR",
        "authorized_official_telephone_number": "410-415-6384",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MD",
            "license": "906136",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MD",
            "license": "906136",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2000351",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON",
            "identifier": "899655",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; 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.