Active NPI
Proactive Pain and Neurology, LLC
- Primary Care Nurse Practitioner
- Cumberland, MD
National Provider Identifier
1669037008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- Legal business name
- PROACTIVE PAIN AND NEUROLOGY, LLC
- Practice address
- 925 Bishop Walsh Rd
Cumberland, MD 21502-1845 - Phone
- (240) 362-7025
- Fax
- (240) 362-7064
- NPI assigned
- May 1, 2019
- Organization subpart
- Yes
- Parent organization
- 1417460619
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dennis Daniel Dey, MD
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | |||
| Primary Care Nurse Practitioner | 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 identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 392004600 | Medicaid | MD | |
| DL77 | Other | MD | CAREFIRST |
| 622188 | Other | MD | MEDICARE |
Other names 1
- Proactive Primary Care
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2166906 | Proactive Primary Care | Certificate of waiver | May 28, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Proactive Pain Neurology
- 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.
-
- Neurology Physician
- Cumberland, MD
- NPI 1417460619
Locations
921 Seton Dr
Ste Fandg
Cumberland, MD 21502
Phone (240) 522-0098
Practitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- Hagerstown, MD
- NPI 1164963963
-
- Nurse Practitioner
- Cumberland, MD
- NPI 1275850638
-
- Registered Nurse
- Lavale, MD
- NPI 1255370524
-
- Primary Care Nurse Practitioner
- Martinsburg, WV
- NPI 1518188614
Primary Care
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "392004600",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "DL77",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "622188",
"state": "MD"
}
],
"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.