C C Neurology LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

C C NEUROLOGY LLC

Practice address

11637 Terrace Dr Ste 100
Waldorf, MD 20602-3707

Phone

(301) 870-7287

NPI assigned

Dec 4, 2023

Organization subpart

No

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

Authorized official

Name

Roche Watson, CRNPNPI 1639522659

Title

Practice Owner

Phone

(301) 870-7287

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 6

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

• Michael K Greenberg, MD

  • Neurology Physician
  • Waldorf, MD
  • NPI 1932192150
  Medicare reassignment Care Compare group NPD
• Roche Watson

  • Family Nurse Practitioner
  • Waldorf, MD
  • NPI 1639522659
  Medicare reassignment NPD Authorized official
• John H Seok, M.D.

  • Neurology Physician
  • Vienna, VA
  • NPI 1770578973

  MD

  Medicare reassignment Care Compare group NPD
• Bernesta Charntel Williams, MD

  • Neurology Physician
  • Shelby, NC
  • NPI 1982804183

  MD

  Medicare reassignment Care Compare group NPD
• Ciara Albrittain

  • Student in an Organized Health Care Education/Training Program
  • Hagerstown, MD
  • NPI 1114613726
  Medicare reassignment
• Kristina Reid, PA-C

  • Medical Physician Assistant
  • Annapolis, MD
  • NPI 1215473087
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1750158374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11637 TERRACE DR STE 100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11637 TERRACE DR STE 100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023707",
            "telephone_number": "301-870-7287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C C NEUROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "ROCHE",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "301-870-7287",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirletta Butler, LCSW-C
• BWN Inc
• Ashleigh Byers, RN
• Sandra Bynaker, PT
• Kerranne Byrd-Taft
• Charryse C Palmer
• Jessica Cabacungan
• Julia Callahan, COTA
• Calvary Health LLC
• Calverthealth Medical Group, LLC

• Neurology Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Neurology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; 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.