NPIMap

Organization Active NPI

Proactive Pain and Neurology, LLC

Doing business as Proactive Primary Care

  • Primary Care Nurse Practitioner
  • Cumberland, MD
National Provider Identifier
1669037008
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PROACTIVE PAIN AND NEUROLOGY, LLC
Doing business as
Proactive Primary Care
Practice address
925 Bishop Walsh Rd
Cumberland, MD 21502-1845
Phone
(240) 362-7025
Fax
(240) 362-7064
NPI assigned
May 1, 2019
Last updated
Dec 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
1417460619As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Authorized official

Name
Dennis Daniel Dey, MDNPI 1972546364
Title
Owner
Phone
(240) 362-7025

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
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

925 Bishop Walsh Rd
Cumberland, MD 21502-1845

Mailing address

PO Box 1602
Cumberland, MD 21501-1602
Phone (240) 362-7025

Other practice location 1

921 Seton Dr Ste Fandg
Cumberland, MD 21502-1852
Phone (240) 522-0098

Other names 1

  • Proactive Primary Care Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2166906Proactive Primary Care925 Bishop Walsh Dr, Cumberland, MD 21502Certificate of waiverMay 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Proactive Pain Neurology2 organizations share this tax ID, including this one
Part of
Proactive Pain Neurology

Other organizations with this tax ID 1

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

Locations

921 Seton Dr
Ste Fandg
Cumberland, MD 21502
Phone (240) 522-0098

925 Bishop Walsh Rd
Ste 10
Cumberland, MD 21502

Practitioners & affiliated clinicians

Practitioners 12

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": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1669037008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1602",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215011602",
            "telephone_number": "240-362-7025",
            "fax_number": "240-362-7064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 BISHOP WALSH RD",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215021845",
            "telephone_number": "240-362-7025",
            "fax_number": "240-362-7064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 Seton Dr Ste Fandg",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215021852",
            "country_code": "US",
            "telephone_number": "240-522-0098",
            "fax_number": "240-522-0099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROACTIVE PAIN AND NEUROLOGY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1417460619",
        "enumeration_date": "2019-05-01",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "DEY",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-362-7025",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumberland, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.