NPIMap

Providence Health Services, Inc

Organization Active NPI Anesthesiology Physician · Washington, DC

NPI 1740795293 · NPPES record last updated Dec 6, 2017

Key facts

NPI
1740795293
Entity type
Organization (NPI type 2)
Primary specialty
Anesthesiology Physician 207L00000X
License
HFD01-0212 (DC)
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Practice address
1150 Varnum St NE
Washington, DC 20017-2104
Phone
(202) 854-4041
Fax
(202) 854-4034
NPI assigned
Dec 6, 2017
Organization subpart
Yes
Parent organization (as reported)
PROVIDENCE HOSPITAL

Authorized official

Name
Beau Higginbothan
Title
Vice President/Coo
Phone
(410) 368-3182

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 87

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 87

Medicare participation

Medicare fee-for-service enrollment
Enrolled in DC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031216000187 DC Part B Supplier - Clinic/Group Practice 4385541622 Receives reassigned benefits from 18 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Washington, DC

National Provider Directory

Part of
PHS Ctr for Geriatric Medicine Dp021

Locations

1150 Varnum St NE
#407
Washington, DC 20017

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207L00000X HFD01-0212 DC Yes
Certified Registered Nurse Anesthetist
Group: 193200000X MULTI-SPECIALTY GROUP		 367500000X HFD01-0212 DC
Anesthesiologist Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 367H00000X HFD01-0212 DC

Addresses

Primary practice location

1150 Varnum St NE
Washington, DC 20017-2104

Mailing address

1150 Varnum St NE
St Catherines Hall, Room 102
20017, DC 20017-2104
Phone (202) 854-4069

Other names

  • PHS Anesthesia Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2017.

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1740795293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST CATHERINES HALL, ROOM 102",
            "city": "20017",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-4041",
            "fax_number": "202-854-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "410-368-3182"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiologist Assistant",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

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Sources for this page

Verify at the official NPI Registry.