Mypotential Clinic - Rockville LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MYPOTENTIAL CLINIC - ROCKVILLE LLC

Practice address

9701 Veirs Dr
Rockville, MD 20850-3414

Phone

(301) 424-9560

NPI assigned

Feb 24, 2017

Organization subpart

Yes

Parent organization

NATIONAL LUTHERAN INCAs reported in NPPES

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

Authorized official

Name

Richard M Mazza

Title

Chief Financial Officer

Phone

(301) 354-2710

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1487894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1497295406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 RESEARCH BLVD",
            "address_2": "SUITE 310",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503204",
            "telephone_number": "301-354-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 VEIRS DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503414",
            "telephone_number": "301-424-9560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYPOTENTIAL CLINIC - ROCKVILLE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NATIONAL LUTHERAN INC",
        "enumeration_date": "2017-02-24",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "MAZZA",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-354-2710"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Rockville, MD
• Providers in Rockville, MD by specialty
• Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.