NPIMap

Organization Active NPI

Outreach Recovery II, LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Hagerstown, MD
National Provider Identifier
1760090294
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
OUTREACH RECOVERY II, LLC
Practice address
240 Frederick St
Hagerstown, MD 21740-6100
Phone
(410) 800-4466
NPI assigned
Jul 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Authorized official

Name
Isiah Coles
Title
Coo
Phone
(561) 502-3978

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X Primary

Addresses

Primary practice location

240 Frederick St
Hagerstown, MD 21740-6100

Mailing address

14205 Park Center Dr # 201202
Laurel, MD 20707-5246
Phone (410) 800-4466

Other identifiers 1

IdentifierTypeStateIssuer
8249491676MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210217000254 MD Part B Supplier - Clinic/Group Practice 5294166302 Receives reassigned benefits from 12 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MD; Hagerstown, MD; Lexington Park, MD; Prince Frederick, MD; Waldorf, MD; Frederick, MD; Easton, MD; Glen Burnie, MD…

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Outreach Recovery II LLC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

222 N Charles St
Ste 101B
Baltimore, MD 21201
Phone (410) 685-8665

29466 Pintail Dr
Ste 2
Easton, MD 21601
Phone (302) 339-9900

196 Thomas Johnson Dr
Ste 201
Frederick, MD 21702

240 Frederick St
Hagerstown, MD 21740
Phone (301) 739-8049

339 E Antietam St
Ste 4
Hagerstown, MD 21740
Phone (240) 330-2430

21552 Thames Ave
Ste 102
Lexington Park, MD 20653

21552 Thames Ave
Ste 201
Lexington Park, MD 20653

11340 Pembrooke Sq
Ste 214
Waldorf, MD 20603
Phone (301) 609-5006

3 Plaza Dr
Ste 16
Toms River, NJ 08757
Phone (732) 505-2888

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1760090294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14205 PARK CENTER DR # 201202",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075246",
            "telephone_number": "410-800-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 FREDERICK ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406100",
            "telephone_number": "410-800-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH RECOVERY II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "COLES",
        "authorized_official_first_name": "ISIAH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "561-502-3978"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8249491676",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.