NPIMap

Organization Active NPI

Active Health Chiropractic, LLC

  • Chiropractor
  • Ellicott City, MD
National Provider Identifier
1821116625
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ACTIVE HEALTH CHIROPRACTIC, LLC
Practice address
3525 Ellicott Mills Dr
Suite F
Ellicott City, MD 21043-4547
Phone
(410) 480-1852
Fax
(410) 480-1857
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

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

Authorized official

Name
Dr. Tracy Marie Ball, D.C.NPI 1992743959
Title
Chiropractor
Phone
(410) 480-1852

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X MD Primary

Addresses

Primary practice location

3525 Ellicott Mills Dr
Suite F
Ellicott City, MD 21043-4547

Mailing address

3525 Ellicott Mills Dr
Suite F
Ellicott City, MD 21043-4547
Phone (410) 480-1852

Other identifiers 2

IdentifierTypeStateIssuer
KCC4OtherMDCAREFIRST
F852OtherMDCAREFIRST DC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050114000725 MD Part B Supplier - Clinic/Group Practice 2567411630 Receives reassigned benefits from 1 practitioner
Practice locations: Sykesville, MD

National Provider Directory

National Provider Directory

Locations

3525 Ellicott Mills Dr
Ste F
Ellicott City, MD 21043
Phone (410) 480-1852

Practitioners & affiliated clinicians

Practitioners 1

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1821116625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3525 ELLICOTT MILLS DR",
            "address_2": "SUITE F",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434547",
            "telephone_number": "410-480-1852",
            "fax_number": "410-480-1857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 ELLICOTT MILLS DR",
            "address_2": "SUITE F",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434547",
            "telephone_number": "410-480-1852",
            "fax_number": "410-480-1857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE HEALTH CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "BALL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "410-480-1852",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "KCC4",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST DC",
            "identifier": "F852",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; 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.