NPIMap

Organization Active NPI

Capital Multi Health Group, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Crofton, MD
National Provider Identifier
1821648312
Registry record updated Sep 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
CAPITAL MULTI HEALTH GROUP, INC
Practice address
2411 Crofton LN Ste 4a
Crofton, MD 21114-1337
Phone
(202) 361-8012
NPI assigned
Sep 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2020

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

Authorized official

Name
James Fonge, MBA
Title
Director
Phone
(202) 361-8012

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

2411 Crofton LN Ste 4a
Crofton, MD 21114-1337

Mailing address

7776 Willow Oak CT
Hanover, MD 21076-2320

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200130000804 MD Part B Supplier - Clinic/Group Practice 6507292125 Receives reassigned benefits from 3 practitioners
Practice locations: Crofton, MD

National Provider Directory

National Provider Directory

Locations

2411 Crofton Ln
Ste 4A
Crofton, MD 21114
Phone (667) 307-4173

Practitioners & affiliated clinicians

Practitioners 3

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": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599696000000",
    "number": "1821648312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7776 WILLOW OAK CT",
            "city": "HANOVER",
            "state": "MD",
            "postal_code": "210762320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 CROFTON LN STE 4A",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211141337",
            "telephone_number": "202-361-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL MULTI HEALTH GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A",
        "authorized_official_last_name": "FONGE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "202-361-8012",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crofton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.