Individual provider Active NPI

Tristan Michael Flack, D.O.

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1750720074
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
284245 Issued in NY
Practice address
6701 N Charles St
Baltimore, MD 21204
Phone
(443) 849-2682
NPI assigned
Jun 19, 2013
Last updated
Aug 30, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 284245 NY Primary

Addresses

Primary practice location

6701 N Charles St
Baltimore, MD 21204

Mailing address

6565 N Charles St Ste 201
Baltimore, MD 21204-5805
Phone (443) 849-2682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180918003035 MD Practitioner - Internal Medicine 1254624265 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Baltimore Medical CenterGroup PAC ID 1759276975, 350 clinicians

Practice addresses (Care Compare)

3701 N Charles St
South Chapman Building Suite 102
Towson, MD 21204-6808

6565 N Charles St
Baltimore, MD 21204-6808

6569 N Charles St
Baltimore, MD 21204-5816

6569 N Charles St
Suite 505
Baltimore, MD 21204-6808
Phone (443) 849-2658

6569 N Charles St PPW Room
307 GYN Specialists
Baltimore, MD 21204-6808
Phone (443) 849-6123

6569 N Charles Street
504 Hoover Low Vision GBMC
Baltimore, MD 21204-6808
Phone (443) 849-2658

6701 N Charles St
Baltamore, MD 21204-6808

6701 N Charles St BLDG
S Chapman BLDG Suite 102
Baltimore, MD 21204-6808

6701 N Charles St Unit
Baltimore, MD 21204-6808
Phone (443) 849-3131

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Baltimore Medical Center, Inc. CurrentSince Aug 13, 2018 Accepting new patients
Greater Baltimore Medical Center, Inc. CurrentSince Aug 13, 2018 Accepting new patients
Greater Baltimore Medical Center, Inc Current Accepting new patients
Greater Baltimore Medical Center, Inc. Past Accepting new patients
Winthrop Community Medical Affiliates PC Internal Medicine Past Accepting new patients

Locations

6565 N Charles St
Ste 201
Towson, MD 21204
Phone (443) 849-2000

6565 N Charles St
Ste 203
Towson, MD 21204
Phone (410) 828-3760

6569 N Charles St
Ste 307
Towson, MD 21204
Phone (443) 849-2767

6569 N Charles St
Ste 505
Towson, MD 21204
Phone (443) 849-2196

6701 N Charles St
Towson, MD 21204
Phone (443) 849-2000

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": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1750720074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 N CHARLES ST STE 201",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212045805",
            "telephone_number": "443-849-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21204",
            "telephone_number": "443-849-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLACK",
        "first_name": "TRISTAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-19",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "284245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.