NPIMap

Organization Active NPI

Tanya R. Sellers-Hannibal, DPM, PC

  • Foot Surgery Podiatrist
  • Owings Mills, MD
National Provider Identifier
1508180712
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
01173 Issued in MD
Legal business name
TANYA R. SELLERS-HANNIBAL, DPM, PC
Practice address
10085 Red Run Blvd
Suite 305
Owings Mills, MD 21117-4836
Phone
(410) 581-8331
Fax
(410) 581-8332
NPI assigned
Mar 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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

Authorized official

Name
Tanya R Sellers-Hannibal, DPMNPI 1972503829
Title
Owner
Phone
(410) 581-8331

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X 01173 MD
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X PO543 DC
Foot Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0131X 01173 MD Primary
Foot Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0131X PO543 DC

Addresses

Primary practice location

10085 Red Run Blvd
Suite 305
Owings Mills, MD 21117-4836

Mailing address

10085 Red Run Blvd
Suite 305
Owings Mills, MD 21117-4836
Phone (410) 581-8331

Other identifiers 1

IdentifierTypeStateIssuer
119128400MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100624000693 MD Part B Supplier - Clinic/Group Practice 7214068956 Receives reassigned benefits from 1 practitioner
Practice locations: Owings Mills, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1508180712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10085 RED RUN BLVD",
            "address_2": "SUITE 305",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174836",
            "telephone_number": "410-581-8331",
            "fax_number": "410-581-8332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10085 RED RUN BLVD",
            "address_2": "SUITE 305",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174836",
            "telephone_number": "410-581-8331",
            "fax_number": "410-581-8332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANYA R. SELLERS-HANNIBAL, DPM, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "SELLERS-HANNIBAL",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-581-8331",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "MD",
            "license": "01173",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "DC",
            "license": "PO543",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "MD",
            "license": "01173",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "DC",
            "license": "PO543",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119128400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.