Individual provider Active NPI

Tsehaye Habteselasie

  • Occupational Therapist
  • Baltimore, MD
National Provider Identifier
1528591542
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
07930 Issued in MD
Practice address
6451 N Charles St
Baltimore, MD 21212-1010
Phone
(187) 740-7342
NPI assigned
Apr 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 07930 MD Primary

Addresses

Primary practice location

6451 N Charles St
Baltimore, MD 21212-1010

Mailing address

6002 Crest Park Dr
Riverdale, MD 20737-3525
Phone (202) 704-3278

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170531001378 MD Practitioner - Occupational Therapist in Private Practice 1658648340 Reassigns benefits to 1 organization
I20170531001472 DC Practitioner - Occupational Therapist in Private Practice 1658648340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Rehab OT MD LLCGroup PAC ID 4981847977, 60 clinicians
Fox Rehabilitation Services LLCGroup PAC ID 1355347410, 304 clinicians

Practice addresses (Care Compare)

6451 N Charles St
Baltimore, MD 21212-1010
Phone (877) 407-3422

9885 Greenbelt Rd
Lanham, MD 20706-2302
Phone (877) 407-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
07930MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehab OT MD LLC Occupational Therapist CurrentSince Apr 24, 2017 Accepting new patients
Fox Rehabilitation Services LLC Occupational Therapist CurrentSince Apr 24, 2017 Accepting new patients

Locations

45 Saint Patricks Dr
Waldorf, MD 20603
Phone (301) 868-7121

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491436800000",
    "number": "1528591542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6002 CREST PARK DR",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207373525",
            "telephone_number": "202-704-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6451 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212121010",
            "telephone_number": "187-740-7342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABTESELASIE",
        "first_name": "TSEHAYE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-06",
        "last_updated": "2017-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "07930",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.