NPIMap

Organization Active NPI

Park West Health System Incorporated

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
National Provider Identifier
1497801153
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PARK WEST HEALTH SYSTEM INCORPORATED
Practice address
4120 Patterson Ave
Baltimore, MD 21215-2254
Phone
(410) 542-7800
Fax
(410) 542-5279
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Authorized official

Name
Mrs. Terri Fields, CPAT, CPC, CCS
Title
Credentialing
Phone
(443) 567-6120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MD Primary

Addresses

Primary practice location

4120 Patterson Ave
Baltimore, MD 21215-2254

Mailing address

3319 W Belvedere Ave
Baltimore, MD 21215-5103
Phone (410) 542-7800

Other identifiers 1

IdentifierTypeStateIssuer
912391100MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120210000176 MD Part A Provider - Federally Qualified Health Center (FQHC) 8921090820 Practice locations: Baltimore, MD

Federally qualified health center certification: CCN 211806

Legal name
PARK WEST HEALTH SYSTEM INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 1991
Last certification
Dec 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
4120 Patterson Ave
Baltimore, MD 21215-2254

Other NPIs with the same Medicare PAC ID 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0865222Park West Health System- Plaza Site4120 Patterson Avenue, Baltimore, MD 21215Provider-performed microscopyJan 27, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shirley Evans Individual Corporate Officer Sep 4, 2007
Dorothy Ball Individual Corporate Officer Sep 4, 2007
Cyrus Lawyer Individual Corporate Officer Jan 1, 1800
Allen Bennett Individual Corporate OfficerCeo Dec 14, 2011
W-2 Managing Employee Dec 14, 2011
Neville Gayle Individual Corporate OfficerCfo Jan 1, 2020
W-2 Managing Employee Jan 1, 2020
Rudolph Isaac Individual Corporate Officer Sep 4, 2007
Deborah E Woolford Individual Corporate Officer Sep 4, 2007
Betty Bell Individual Corporate Officer Sep 4, 2007

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

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": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1497801153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 W BELVEDERE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155103",
            "telephone_number": "410-542-7800",
            "fax_number": "410-542-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 PATTERSON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212152254",
            "telephone_number": "410-542-7800",
            "fax_number": "410-542-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK WEST HEALTH SYSTEM INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "FIELDS",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "443-567-6120",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPAT, CPC, CCS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "912391100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.