Immaculate Medical Services LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD22148 Issued in DC

Legal business name

IMMACULATE MEDICAL SERVICES LLC

Practice address

106 Irving St NW
Suite 308 South
Washington, DC 20010-2927

Phone

(202) 877-0400

Fax

(202) 877-0584

NPI assigned

Jul 19, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Ann Marie Gordon, MD

Title

Ceo

Phone

(202) 877-0400

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2675/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1821301904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 GATEWOOD PL",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209031505",
            "telephone_number": "301-257-5033",
            "fax_number": "301-408-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 IRVING ST NW",
            "address_2": "SUITE 308 SOUTH",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102927",
            "telephone_number": "202-877-0400",
            "fax_number": "202-877-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-19",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ANN MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "202-877-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "DC",
            "license": "MD22148",
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "DC",
            "license": "MD22148",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Immaculata Supports, Inc.
• Immaculate Health Care Services Inc.
• Immaculate Health Care Services Inc.
• Immaculate Health Care Services,Inc
• Immaculate Health Care Services,Inc
• Shanan Ray Immel, MD
• Immense Services Inc
• Amanda Vahini Immidisetti, MD
• Omolara Imoemiye
• Osarimabo David Imoisili, M.D.

• Primary Care Clinic/Center in Washington, DC
• Providers in Washington, DC by specialty
• Primary Care Clinic/Center in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.