Organization Active NPI

Gaithersburg Mental Health Associates, LLC

  • Child & Adolescent Psychiatry Physician
  • Gaithersburg, MD
National Provider Identifier
1700112083
Registry record updated Dec 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
GAITHERSBURG MENTAL HEALTH ASSOCIATES, LLC
Practice address
915 Russell Ave
A
Gaithersburg, MD 20879-3202
Phone
(301) 948-1769
Fax
(301) 990-7111
NPI assigned
Oct 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2010

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

Authorized official

Name
Sunny Singh
Title
Office Administrator
Phone
(301) 948-1769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

915 Russell Ave
A
Gaithersburg, MD 20879-3202

Mailing address

915 Russell Ave
A
Gaithersburg, MD 20879-3202
Phone (301) 948-1769

Other identifiers 1

IdentifierTypeStateIssuer
146691700MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050223000852 DC Part B Supplier - Clinic/Group Practice 7618920240 Receives reassigned benefits from 1 practitioner
Practice locations: Gaithersburg, MD

National Provider Directory

National Provider Directory

Locations

915 Russell Ave
Gaithersburg, MD 20879
Phone (301) 948-1769

Practitioners & affiliated clinicians

Practitioners 3

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": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292544000000",
    "number": "1700112083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 RUSSELL AVE",
            "address_2": "A",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793202",
            "telephone_number": "301-948-1769",
            "fax_number": "301-990-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 RUSSELL AVE",
            "address_2": "A",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793202",
            "telephone_number": "301-948-1769",
            "fax_number": "301-990-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAITHERSBURG MENTAL HEALTH ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2010-12-17",
        "status": "A",
        "authorized_official_last_name": "SINGH",
        "authorized_official_first_name": "SUNNY",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "301-948-1769"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146691700",
            "state": "MD"
        }
    ],
    "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 Dec 17, 2010; 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.