NPIMap

Organization Active NPI

Providence Health Services, Inc

Doing business as PHS Outpatient Behavioral Health

  • Neurology Physician
  • Washington, DC
National Provider Identifier
1609031632
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
HFD01-0212 Issued in DC
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Doing business as
PHS Outpatient Behavioral Health
Practice address
1140 Varnum St NE Ste 100
Washington, DC 20017
Phone
(202) 854-7623
Fax
(202) 854-7616
NPI assigned
Jul 18, 2008
Last updated
Oct 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Mitchell Lomax
Title
Vice President/Cfo
Phone
(667) 234-2926

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X HFD01-0212 DC
Psychologist 103T00000X HFD01-0212 DC
Social Worker 104100000X HFD01-0212 DC
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X HFD01-0212 DC
Neurology Physician 2084N0400X HFD01-0212 DC Primary
Behavioral Neurology & Neuropsychiatry Physician 2084B0040X HFD01-0212 DC

Addresses

Primary practice location

1140 Varnum St NE Ste 100
Washington, DC 20017

Mailing address

1150 Varnum St NE
St Catherines Hall 102
Washington, DC 20017-2180
Phone (202) 854-4069

Other identifiers 1

IdentifierTypeStateIssuer
985415100MedicaidMD

Other names 1

  • PHS Outpatient Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PHS Emergency Room Serv18 organizations share this tax ID, including this one
Part of
Emerg Med Providence Ho

Other organizations with this tax ID 17

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

View all 17

Locations

1150 Varnum St NE
#102
Washington, DC 20017

Practitioners & affiliated clinicians

Practitioners 6

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": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1609031632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST CATHERINES HALL 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172180",
            "telephone_number": "202-854-4069",
            "fax_number": "202-269-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 VARNUM ST NE STE 100",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20017",
            "telephone_number": "202-854-7623",
            "fax_number": "202-854-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2008-07-18",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "LOMAX",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "667-234-2926"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "985415100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS Outpatient Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHS Outpatient Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.