Maple Grove Medical, Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0101242147 Issued in VA

Legal business name

MAPLE GROVE MEDICAL, INC.

Doing business as

Rebecca Ingram, MD

Practice address

316 Maple Tree LN
Spring Grove, VA 23881-8515

Phone

(804) 955-0965

NPI assigned

May 16, 2011

Last updated

May 16, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rebecca Harding Ingram, M.D.NPI 1275861817

Title

Ceo, Physician

Phone

(804) 955-0965

Specialties & licenses 1

Addresses

Other names 1

• Rebecca Ingram, MD Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 2

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.

• Rebecca Harding Ingram, MD

  • Geriatric Psychiatry Physician
  • Spring Grove, VA
  • NPI 1275861817
  Medicare reassignment NPD Authorized official
• Ellen Elaine Tinsley, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Ashland, VA
  • NPI 1578833828
  NPD (past)

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1821381427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 MAPLE TREE LN",
            "city": "SPRING GROVE",
            "state": "VA",
            "postal_code": "238818515",
            "telephone_number": "804-955-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MAPLE TREE LN",
            "city": "SPRING GROVE",
            "state": "VA",
            "postal_code": "238818515",
            "telephone_number": "804-955-0965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-16",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "HARDING",
        "authorized_official_title_or_position": "CEO, PHYSICIAN",
        "authorized_official_telephone_number": "804-955-0965",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101242147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rebecca Ingram, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Josephine Daniels
• Hale Psychiatry & Wellness, PLLC
• George R Headley
• Rebecca Harding Ingram, MD
• Jane Lee White, SFA

• Psychiatry Physician in Spring Grove, VA
• Providers in Spring Grove, VA by specialty
• Psychiatry Physician in Virginia

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