NPIMap

Organization Active NPI

Pinnacle Center for Mental Health & Human Relations LLC

  • Mental Health Counselor
  • Waldorf, MD
National Provider Identifier
1760439830
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PINNACLE CENTER FOR MENTAL HEALTH & HUMAN RELATIONS LLC
Practice address
603 Post Office Rd
Suite 210
Waldorf, MD 20602-1914
Phone
(301) 705-7593
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

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

Authorized official

Name
Dr. Charles L Ruby, PH.D.NPI 1649310715
Title
General Manager
Phone
(301) 705-7593

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

603 Post Office Rd
Suite 210
Waldorf, MD 20602-1914

Mailing address

603 Post Office Rd
Suite 210
Waldorf, MD 20602-1914

Other identifiers 1

IdentifierTypeStateIssuer
194401100MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110819000345 MD Part B Supplier - Clinic/Group Practice 9335319888 Receives reassigned benefits from 11 practitioners
Practice locations: Waldorf, MD

National Provider Directory

National Provider Directory

Locations

603 Post Office Rd
Ste 210
Waldorf, MD 20602
Phone (301) 705-7593

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1760439830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 POST OFFICE RD",
            "address_2": "SUITE 210",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 POST OFFICE RD",
            "address_2": "SUITE 210",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021914",
            "telephone_number": "301-705-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE CENTER FOR MENTAL HEALTH & HUMAN RELATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "RUBY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "301-705-7593",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194401100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; 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.