Chase Brexton Health Services, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CHASE BREXTON HEALTH SERVICES, INC.

Practice address

3510 Brenbrook Drive
Randallstown, MD 21201-5442

Phone

(410) 496-6441

Fax

(410) 496-6448

NPI assigned

Feb 2, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Kyle Easton

Title

Revenue Cycle Director

Phone

(410) 837-2050

Specialties & licenses 8

Addresses

Other names 1

• Chase Brexton Health Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Federally qualified health center certification: CCN 211850

Legal name

CHASE BREXTON HEALTH SERVICES INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 6, 2005

Last certification

Dec 6, 2005

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 1, 1989 in MD

Enrollment address

6901 Security Blvd
Ste 200
Windsor Mill, MD 21244-2412

Other NPIs on the same Medicare enrollment 1

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

• Chase Brexton Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Windsor Mill, MD
  • NPI 1851320147

  O20100908000867

  Same enrollment

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Rahul Gor, DPM

  • Podiatrist
  • Laurel, MD
  • NPI 1083665640

  Corporate Director

  CMS ownership
• Damian Crawford, M.D.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1063686327

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1750687166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 NORTH CHARLES STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "telephone_number": "410-837-2050",
            "fax_number": "410-752-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 BRENBROOK DRIVE",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "212015442",
            "telephone_number": "410-496-6441",
            "fax_number": "410-496-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHASE BREXTON HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "410-837-2050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Randallstown, MD
• Providers in Randallstown, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.