NPIMap

Organization Active NPI

My Home Telemed LLC

  • Primary Care Clinic/Center
  • Venice, FL
National Provider Identifier
1548848906
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MY HOME TELEMED LLC
Practice address
1156 Piedmont Rd
Venice, FL 34293-4843
Phone
(609) 432-5417
NPI assigned
Mar 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Dr. Denise S Trumbauer, DNP, APN,BCNPI 1477558351
Title
Owner, Ceo
Phone
(609) 432-5417

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1156 Piedmont Rd
Venice, FL 34293-4843

Mailing address

106 Anita Dr
Egg Harbor Township, NJ 08234-7522
Phone (609) 432-5417

Other practice location 1

106 Anita Dr
Egg Harbor Township, NJ 08234-7522
Phone (609) 432-5417

Other identifiers 1

IdentifierTypeStateIssuer
60062926MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210712003378 NJ Part B Supplier - Clinic/Group Practice 2860800489 Receives reassigned benefits from 1 practitioner
Practice locations: Somers Point, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1616976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1548848906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 ANITA DR",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082347522",
            "telephone_number": "609-432-5417",
            "fax_number": "609-788-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1156 PIEDMONT RD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342934843",
            "telephone_number": "609-432-5417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Anita Dr",
            "address_purpose": "LOCATION",
            "city": "Egg Harbor Township",
            "state": "NJ",
            "postal_code": "082347522",
            "country_code": "US",
            "telephone_number": "609-432-5417",
            "fax_number": "609-788-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MY HOME TELEMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "TRUMBAUER",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "609-432-5417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, APN,BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60062926",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.