NPIMap

Organization Active NPI

Providence Health Services, Inc

  • Family Medicine Physician
  • Washington, DC
National Provider Identifier
1619245222
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Practice address
128 M St NW
Washington, DC 20001-1205
Phone
(202) 682-3840
Fax
(202) 682-3854
NPI assigned
Dec 9, 2011
Last updated
Feb 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

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

Authorized official

Name
Mr. Beau Higginbotham
Title
Vice President/Coo
Phone
(410) 638-3162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

128 M St NW
Washington, DC 20001-1205

Mailing address

1150 Varnum St NE RM 407
Washington, DC 20017-2180
Phone (202) 854-4069

Other practice location 1

1150 Varnum St NE Rm 407
Washington, DC 20017-2180
Phone (202) 854-4069

Other names 1

  • Providence Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Emerg Med Providence Ho23 organizations share this tax ID, including this one
Part of
Emerg Med Providence Ho

Other organizations with this tax ID 22

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

View all 22

Locations

1150 Varnum St NE
Rm 407
Washington, DC 20017
Phone (202) 854-4069

Practitioners & affiliated clinicians

Practitioners 3

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": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1619245222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE RM 407",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172180",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 M ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200011205",
            "telephone_number": "202-682-3840",
            "fax_number": "202-682-3854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 Varnum St NE Rm 407",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200172180",
            "country_code": "US",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2011-12-09",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "410-638-3162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 6, 2020; 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.