NPIMap

Organization Active NPI

Outreach Recovery II, LLC

  • Addiction Medicine (Preventive Medicine) Physician
  • Waldorf, MD
National Provider Identifier
1801452362
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X
Legal business name
OUTREACH RECOVERY II, LLC
Practice address
11340 Pembrooke SQ Ste 214
Waldorf, MD 20603-4808
Phone
(410) 800-4466
NPI assigned
May 10, 2019
Last updated
Jul 31, 2024By the provider in NPPES
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X
Addiction Medicine (Preventive Medicine) Physician 2083A0300X Primary

Addresses

Primary practice location

11340 Pembrooke SQ Ste 214
Waldorf, MD 20603-4808

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
777797300MedicaidMD

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1801452362",
    "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": "11340 PEMBROOKE SQ STE 214",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034808",
            "telephone_number": "410-800-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH RECOVERY II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-10",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "777797300",
            "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 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.