NPIMap

Organization Active NPI

Brook Lane Health Services

  • Psychiatric Hospital
  • Hagerstown, MD
National Provider Identifier
1780659136
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
21-002 Issued in MD
Legal business name
BROOK LANE HEALTH SERVICES
Practice address
13215 Brook Lane
Hagerstown, MD 21742-1514
Phone
(301) 733-0330
Fax
(301) 733-4038
NPI assigned
Feb 21, 2006
Reactivated
Sep 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Authorized official

Name
Mrs. Kristy Poffenberger
Title
Coordinator/Managed Care
Phone
(301) 733-0331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 21-002 MD Primary

Addresses

Primary practice location

13215 Brook Lane
Hagerstown, MD 21742-1514

Mailing address

13215 Brook Lane
Hagerstown, MD 21742-1435
Phone (301) 733-0330

Other identifiers 1

IdentifierTypeStateIssuer
986965400MedicaidMD

Other names 1

  • Chronic Onsite Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040521000256 MD Part B Supplier - Clinic/Group Practice 9436140068 Receives reassigned benefits from 25 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hagerstown, MD; Frederick, MD

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1780659136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13215 BROOK LANE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421435",
            "telephone_number": "301-733-0330",
            "fax_number": "301-733-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13215 BROOK LANE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421514",
            "telephone_number": "301-733-0330",
            "fax_number": "301-733-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOK LANE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "deactivation_date": "2018-05-31",
        "reactivation_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "POFFENBERGER",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "COORDINATOR/MANAGED CARE",
        "authorized_official_telephone_number": "301-733-0331",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "MD",
            "license": "21-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "986965400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chronic Onsite",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 6, 2022; 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.