NPIMap

Organization Active NPI

Montgomery Wellness Hub LLC

  • Behavioral Neurology & Neuropsychiatry Physician
  • Gaithersburg, MD
National Provider Identifier
1679236954
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
MONTGOMERY WELLNESS HUB LLC
Practice address
951 Russell Ave Ste D
Gaithersburg, MD 20879-3283
Phone
(301) 404-7336
NPI assigned
Oct 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Authorized official

Name
Mohammed Kolawole Ibrahim
Title
Ceo
Phone
(301) 404-7336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084B0040X Primary

Addresses

Primary practice location

951 Russell Ave Ste D
Gaithersburg, MD 20879-3283

Mailing address

951 Russell Ave Ste D
Gaithersburg, MD 20879-3283
Phone (301) 404-7336

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240829001653 DC Part B Supplier - Clinic/Group Practice 3173062569 Receives reassigned benefits from 4 practitioners
Practice locations: Gaithersburg, MD

National Provider Directory

National Provider Directory
Tax ID family
Montgomery Wellness Hub LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1679236954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 RUSSELL AVE STE D",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793283",
            "telephone_number": "301-404-7336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 RUSSELL AVE STE D",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793283",
            "telephone_number": "301-404-7336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY WELLNESS HUB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "KOLAWOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-404-7336"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.