Individual provider Active NPI

Mary Tessie Thullah Bangura, DNP-PMHNP

  • Gerontology Nurse Practitioner
  • Washington, DC
National Provider Identifier
1740956531
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
NP1009163 Issued in DC
Practice address
2603 Hamlin St NE
Washington, DC 20018-2530
Phone
(202) 730-6559
NPI assigned
Aug 20, 2021
Last updated
Jul 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X R161437 MD
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP1009163 DC
Gerontology Nurse Practitioner 363LG0600X NP1009163 DC Primary

Addresses

Primary practice location

2603 Hamlin St NE
Washington, DC 20018-2530

Mailing address

5055 Seminary Rd Apt 239
Alexandria, VA 22311-2004
Phone (202) 730-6559

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250821001741 DC Practitioner - Nurse Practitioner 0547618167 Reassigns benefits to 4 organizations
I20260223001302 MD Practitioner - Nurse Practitioner 0547618167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Mental and Relaxation Clinic IncGroup PAC ID 4284177684, 2 clinicians
Accent on Health LLCGroup PAC ID 3476653924, 3 clinicians

Practice addresses (Care Compare)

12312 Quail Woods Dr
Germantown, MD 20874-1542
Phone (240) 241-8408

5643 Scott Ridge PL
Frederick, MD 21704-6755
Phone (240) 421-8408

650 Pennsylvania Ave SE
Suite 330
Washington, DC 20003-4397
Phone (202) 610-9570

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R161437MDMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Elevate Health Solutions, LLC Psychiatric/Mental Health CurrentSince Jun 8, 2025 Accepting new patients
Comprehensive Mental & Relaxation Clinic Inc CurrentSince Jan 12, 2026 Accepting new patients
Elevate Health Solutions, LLC Current Accepting new patients
RB Angels Haven Health Center PLLC Gerontology CurrentSince Apr 1, 2026 Accepting new patients

Locations

650 Pennsylvania Ave SE
Ste 330
Washington, DC 20003
Phone (202) 610-9570

121 Congressional Ln
Ste 316
Rockville, MD 20852
Phone (240) 221-3116

Organizations & group practices 5

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 1

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": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1740956531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5055 SEMINARY RD APT 239",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223112004",
            "telephone_number": "202-730-6559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 HAMLIN ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200182530",
            "telephone_number": "202-730-6559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THULLAH BANGURA",
        "first_name": "MARY",
        "middle_name": "TESSIE",
        "credential": "DNP-PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R161437",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DC",
            "license": "NP1009163",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "DC",
            "license": "NP1009163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.