NPIMap

Organization Active NPI

Backpack Medical Group, P.C.

  • Clinical Social Worker
  • Elkridge, MD
National Provider Identifier
1851177570
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BACKPACK MEDICAL GROUP, P.C.
Practice address
6655 Santa Barbara Rd Unit 8574
Elkridge, MD 21075-7523
Phone
(866) 968-6342
Fax
(855) 615-2876
NPI assigned
Sep 7, 2023
Last updated
Aug 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Authorized official

Name
Dr. Duke Ruktanonchai, MDNPI 1629181037
Title
President/Owner
Phone
(630) 306-4394

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Counselor 101Y00000X NU
Professional Counselor 101YP2500X NU
Psychologist 103T00000X NU
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU Primary
Child & Adolescent Psychiatry Physician 2084P0804X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

6655 Santa Barbara Rd Unit 8574
Elkridge, MD 21075-7523

Mailing address

6655 Santa Barbara Rd Unit 8574
Elkridge, MD 21075-7523
Phone (630) 306-4394

Other practice location 1

2810 E Oakland Park Blvd Ste 200-14
Fort Lauderdale, FL 33306-1801
Phone (866) 968-6342

Other practice location 2

191 Peachtree St NE Ste 1400
Atlanta, GA 30303-1749
Phone (866) 968-6342

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, VA, GA, MI, KY, IL6 enrollments

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20240111003427 MD Part B Supplier - Clinic/Group Practice 6507217742 Receives reassigned benefits from 41 practitioners
Practice locations: Catonsville, MD
O20240322000921 VA Part B Supplier - Clinic/Group Practice 6507217742 Receives reassigned benefits from 24 practitioners
Practice locations: Sterling, VA
O20240723003827 GA Part B Supplier - Clinic/Group Practice 6507217742 Receives reassigned benefits from 13 practitioners
Practice locations: Atlanta, GA; Newnan, GA
O20241203001182 MI Part B Supplier - Clinic/Group Practice 6507217742 Receives reassigned benefits from 5 practitioners
Practice locations: Dearborn, MI
O20250320000481 KY Part B Supplier - Clinic/Group Practice 6507217742 Receives reassigned benefits from 2 practitioners
Practice locations: Lexington, KY
O20250812002864 IL Part B Supplier - Clinic/Group Practice 6507217742 Receives reassigned benefits from 6 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

2810 E Oakland Park Blvd
Ste 20014
Fort Lauderdale, FL 33306

191 Peachtree St NE
Ste 1400
Atlanta, GA 30303

400 N Aberdeen St
Chicago, IL 60642

6655 Santa Barbara Rd
Unit 8574
Elkridge, MD 21075
Phone (301) 578-5166

Practitioners & affiliated clinicians

Practitioners 69

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.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754352000000",
    "number": "1851177570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6655 SANTA BARBARA RD UNIT 8574",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210757523",
            "telephone_number": "630-306-4394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6655 SANTA BARBARA RD UNIT 8574",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210757523",
            "telephone_number": "866-968-6342",
            "fax_number": "855-615-2876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2810 E Oakland Park Blvd Ste 200-14",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333061801",
            "country_code": "US",
            "telephone_number": "866-968-6342",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "191 Peachtree St NE Ste 1400",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303031749",
            "country_code": "US",
            "telephone_number": "866-968-6342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BACKPACK MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-07",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A",
        "authorized_official_last_name": "RUKTANONCHAI",
        "authorized_official_first_name": "DUKE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-306-4394",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.