Individual provider Active NPI

Eveline Takang

  • Gerontology Nurse Practitioner
  • Beltsville, MD
National Provider Identifier
1548528599
Registry record updated Mar 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
R167174 Issued in MD
Practice address
12904 Northampton Dr
Beltsville, MD 20705-6332
Phone
(240) 264-9698
NPI assigned
Apr 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X R167174 MD Primary

Addresses

Primary practice location

12904 Northampton Dr
Beltsville, MD 20705-6332

Mailing address

12904 Northampton Dr
Beltsville, MD 20705-6332
Phone (240) 264-9698

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171114000046 MD Practitioner - Nurse Practitioner 2466692207 Reassigns benefits to 2 organizations
I20190117001263 DC Practitioner - Nurse Practitioner 2466692207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8117 Harford Rd
Suite 2
Baltimore, MD 21234-5792
Phone (410) 882-4800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R167174MDMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
House Calls of the District of Columbia Inc CurrentSince Jan 9, 2019 Accepting new patients
First Medicine Clinical Associates Inc. CurrentSince May 15, 2019 Accepting new patients
House Calls of the District of Columbia Inc CurrentSince Jan 9, 2019 Accepting new patients
E & T Healthcare Enterprise Past Accepting new patients

Locations

4560 Crain Hwy
Ste 10
White Plains, MD 20695
Phone (202) 683-4340

Organizations & group practices 5

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": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490400000000",
    "number": "1548528599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12904 NORTHAMPTON DR",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207056332",
            "telephone_number": "240-264-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12904 NORTHAMPTON DR",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207056332",
            "telephone_number": "240-264-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKANG",
        "first_name": "EVELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-27",
        "last_updated": "2017-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R167174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beltsville, MD

Sources for this page

Verify at the official NPI Registry.