NPIMap

Organization Active NPI

Elite Weightloss & TRT

Doing business as JE Primary and Mental Health Clinic

  • Nurse Practitioner
  • Mount Airy, MD
National Provider Identifier
1568283547
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ELITE WEIGHTLOSS & TRT
Doing business as
JE Primary and Mental Health Clinic
Practice address
1604 Ridgeside Dr Ste B2
Mount Airy, MD 21771-5240
Phone
(410) 498-7055
NPI assigned
Oct 22, 2024
Last updated
Jul 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Authorized official

Name
Mrs. Emilienne Nkemayim, CRNPNPI 1093224149
Title
Owner
Phone
(410) 498-7055

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

1604 Ridgeside Dr Ste B2
Mount Airy, MD 21771-5240

Mailing address

1604 Ridgeside Dr Ste B2
Mount Airy, MD 21771-5240
Phone (410) 498-7055

Other names 1

  • JE Primary and Mental Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241231003275 MD Part B Supplier - Clinic/Group Practice 2567999642 Receives reassigned benefits from 1 practitioner
Practice locations: Mount Airy, MD

National Provider Directory

National Provider Directory

Locations

1604 Ridgeside Dr
Ste B2
Mount Airy, MD 21771
Phone (410) 498-7055

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1568283547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 RIDGESIDE DR STE B2",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715240",
            "telephone_number": "410-498-7055",
            "fax_number": "410-862-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 RIDGESIDE DR STE B2",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715240",
            "telephone_number": "410-498-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE WEIGHTLOSS & TRT",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "NKEMAYIM",
        "authorized_official_first_name": "EMILIENNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-498-7055",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JE Primary and Mental Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Airy, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; 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.