NPIMap

Individual provider Active NPI

Trung H Pham, M.D.

  • Internal Medicine Physician
  • Randallstown, MD
National Provider Identifier
1669491999
Registry record updated Oct 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0047704 Issued in MD
Practice address
5415 Old Court Rd
Suite 102
Randallstown, MD 21133-5103
Phone
(410) 701-4600
Fax
(410) 701-4481
NPI assigned
Jul 18, 2006
Last updated
Oct 15, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0047704 MD Primary

Addresses

Primary practice location

5415 Old Court Rd
Suite 102
Randallstown, MD 21133-5103

Mailing address

6509 Early Lily Row
Columbia, MD 21044-6057
Phone (410) 701-4600

Other identifiers 3

IdentifierTypeStateIssuer
450P881GOtherMDMEDICARE INDIVIDUAL PTAN
450POtherMDMEDICARE GROUP PTAN
484802100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070711000878 MD Practitioner - Internal Medicine 5698875284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5415 Old Court Rd
Suite 102
Randallstown, MD 21133-5172
Phone (410) 701-4600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0047704MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trung Hoa Pham, MD, LLC Internal Medicine CurrentSince Feb 5, 2007 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

5415 Old Court Rd
Ste 102
Randallstown, MD 21133
Phone (410) 701-4600

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CAGBDA
  • FHIR API: https://fhir4.healow.com/fhir/r4/CAGBDA/Endpoint/CAGBDA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1669491999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6509 EARLY LILY ROW",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210446057",
            "telephone_number": "410-701-4600",
            "fax_number": "410-701-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 OLD COURT RD",
            "address_2": "SUITE 102",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-701-4600",
            "fax_number": "410-701-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "TRUNG",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0047704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "450P881G",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "450P",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "484802100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Randallstown, MD

Sources for this page

Verify at the official NPI Registry.