NPIMap

Organization Active NPI

Port Recovery Iop Inc.

  • Mental Health Counselor
  • Nottingham, MD
National Provider Identifier
1578026464
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PORT RECOVERY IOP INC.
Practice address
8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Phone
(443) 869-4909
Fax
(443) 869-4928
NPI assigned
Apr 9, 2019
Last updated
Apr 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Joanne Granruth
Title
Owner
Phone
(410) 534-8735

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028

Mailing address

8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Phone (443) 869-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190919000034 MD Part B Supplier - Clinic/Group Practice 2961650551 Receives reassigned benefits from 4 practitioners
Practice locations: Nottingham, MD

National Provider Directory

National Provider Directory
Tax ID family
Port Recovery Iop Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1578026464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8615 RIDGELYS CHOICE DR STE 205",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212363028",
            "telephone_number": "443-869-4909",
            "fax_number": "443-869-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8615 RIDGELYS CHOICE DR STE 205",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212363028",
            "telephone_number": "443-869-4909",
            "fax_number": "443-869-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT RECOVERY IOP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "GRANRUTH",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-534-8735"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.