Active NPI
Old Greenbelt Family Health
- Family Nurse Practitioner
- Greenbelt, MD
National Provider Identifier
1760157713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- OLD GREENBELT FAMILY HEALTH
- Practice address
- 115 Centerway Ste 104
Greenbelt, MD 20770-1836 - Phone
- (866) 282-5040
- Fax
- (609) 482-8118
- NPI assigned
- Aug 11, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Salma Khan
- Title
- Authorized Official
- Phone
- (866) 282-5040
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
115 Centerway Ste 104
Greenbelt, MD 20770-1836
Mailing address
115 Centerway Ste 104
Greenbelt, MD 20770-1836
Phone (866) 282-5040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R235180 | Other | MD | STATE LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | OldGreenbeltFamilyHealth |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211214000019 | DC | Part B Supplier - Clinic/Group Practice | 2860882479 |
Receives reassigned benefits from 1 practitioner Practice locations: Greenbelt, MD |
National Provider Directory
National Provider Directory- Tax ID family
- Old Greenbelt Family Health
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Nurse Practitioner
- Greenbelt, MD
- NPI 1174331243
Locations
115 Centerway
Ste 104
Greenbelt, MD 20770
Phone (240) 424-0697
Ownership & related parties
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Family Nurse Practitioner
- Greenbelt, MD
- NPI 1174331243
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628640000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1628640000000",
"number": "1760157713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 CENTERWAY STE 104",
"city": "GREENBELT",
"state": "MD",
"postal_code": "207701836",
"telephone_number": "866-282-5040",
"fax_number": "609-482-8118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 CENTERWAY STE 104",
"city": "GREENBELT",
"state": "MD",
"postal_code": "207701836",
"telephone_number": "866-282-5040",
"fax_number": "609-482-8118"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OLD GREENBELT FAMILY HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-11",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A",
"authorized_official_last_name": "KHAN",
"authorized_official_first_name": "SALMA",
"authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "866-282-5040"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "R235180",
"state": "MD"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "OldGreenbeltFamilyHealth",
"affiliation": "N",
"address_1": "115 Centerway Ste 104",
"city": "Greenbelt",
"state": "MD",
"country_code": "US",
"postal_code": "207701836",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Greenbelt, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.