NPIMap

Organization Active NPI

Renaissance Primary Care and Wellness Group LLC

  • Family Medicine Physician
  • Columbia, MD
National Provider Identifier
1609097112
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0060109 Issued in MD
Legal business name
RENAISSANCE PRIMARY CARE AND WELLNESS GROUP LLC
Practice address
5500 Knoll North Dr
Suite 250
Columbia, MD 21045-2209
Phone
(410) 772-8001
Fax
(410) 772-8004
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

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

Authorized official

Name
Lindiwe F Greenwood, MDNPI 1932147881
Title
Owner Physician
Phone
(410) 772-8001

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X D0060109 MD Primary

Addresses

Primary practice location

5500 Knoll North Dr
Suite 250
Columbia, MD 21045-2209

Mailing address

5500 Knoll North Dr
Suite 250
Columbia, MD 21045-2209
Phone (410) 772-8001

Other identifiers 3

IdentifierTypeStateIssuer
405788100MedicaidMD
75XBLFOtherMDMD BLUE SHIELD
33760001OtherMDBLUE CHOICE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1609097112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR",
            "address_2": "SUITE 250",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452209",
            "telephone_number": "410-772-8001",
            "fax_number": "410-772-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR",
            "address_2": "SUITE 250",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452209",
            "telephone_number": "410-772-8001",
            "fax_number": "410-772-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE PRIMARY CARE AND WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "GREENWOOD",
        "authorized_official_first_name": "LINDIWE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "410-772-8001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0060109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405788100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD BLUE SHIELD",
            "identifier": "75XBLF",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "33760001",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.