NPIMap

Organization Active NPI

Anthem Behavioral Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Cockeysville, MD
National Provider Identifier
1497570402
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ANTHEM BEHAVIORAL HEALTH, LLC
Practice address
201 International Cir Ste 230
Cockeysville, MD 21030-1344
Phone
(443) 567-6091
Fax
(443) 567-6191
NPI assigned
Nov 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Jennifer Petrik
Title
Ceo
Phone
(443) 567-6091

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

201 International Cir Ste 230
Cockeysville, MD 21030-1344

Mailing address

404 N Hickory Ave
Bel Air, MD 21014-3227
Phone (410) 459-7699

Other names 1

  • Anthem Behavioral Health, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250409000569 MD Part B Supplier - Clinic/Group Practice 5799209946 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bel Air, MD; Cockeysville, MD

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
Tax ID family
Anthem Behavioral Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners 2

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": "1731628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1497570402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 N HICKORY AVE",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143227",
            "telephone_number": "410-459-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 INTERNATIONAL CIR STE 230",
            "city": "COCKEYSVILLE",
            "state": "MD",
            "postal_code": "210301344",
            "telephone_number": "443-567-6091",
            "fax_number": "443-567-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHEM BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-15",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "PETRIK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-567-6091"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anthem Behavioral Health, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Anthem Behavioral Health, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cockeysville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.