NPIMap

Organization Active NPI

Pricare Medical Center LLC

  • Primary Care Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1669983904
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PRICARE MEDICAL CENTER LLC
Practice address
8113 Harford Rd Ste 100
Baltimore, MD 21234-5790
Phone
(410) 882-4800
NPI assigned
Oct 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

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

Authorized official

Name
Eveline Takang, CRNPNPI 1548528599
Title
Owner
Phone
(240) 264-9698

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
Primary Care Clinic/Center 261QP2300X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

8113 Harford Rd Ste 100
Baltimore, MD 21234-5790

Mailing address

8113 Harford Rd Ste 100
Baltimore, MD 21234-5790

Other identifiers 1

IdentifierTypeStateIssuer
983319600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171114000029 MD Part B Supplier - Clinic/Group Practice 8224394911 Receives reassigned benefits from 1 practitioner
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory

Locations

8117 Harford Rd
Ste 2
Parkville, MD 21234
Phone (301) 814-5610

Practitioners & affiliated clinicians

Practitioners 2

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": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1669983904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8113 HARFORD RD STE 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212345790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8113 HARFORD RD STE 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212345790",
            "telephone_number": "410-882-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRICARE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "TAKANG",
        "authorized_official_first_name": "EVELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-264-9698",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "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": "983319600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.