NPIMap

Organization Active NPI

Dej Med Practice, LLC

Doing business as Partners in Pediatrics and Family Health

  • Pediatrics Physician
  • Hagerstown, MD
National Provider Identifier
1851515902
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
DEJ MED PRACTICE, LLC
Doing business as
Partners in Pediatrics and Family Health
Practice address
303 Memorial Blvd W
Hagerstown, MD 21740-6219
Phone
(301) 791-7060
Fax
(301) 791-8990
NPI assigned
Apr 12, 2007
Last updated
Nov 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Authorized official

Name
Chukuemeka Obidi, M.D.
Title
President
Phone
(301) 791-7060

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

303 Memorial Blvd W
Hagerstown, MD 21740-6219

Mailing address

303 Memorial Blvd W
Hagerstown, MD 21740-6219
Phone (301) 791-7060

Other names 1

  • Partners in Pediatrics and Family Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170308000174 MD Part B Supplier - Clinic/Group Practice 7810271004 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Hagerstown, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0220757Partners in Pediatrics303 West Memorial Boulevard, Hagerstown, MD 21740Certificate of waiverApr 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dej Med Practice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13316 Marsh Pike
Hagerstown, MD 21742
Phone (301) 791-7060

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1851515902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 MEMORIAL BLVD W",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406219",
            "telephone_number": "301-791-7060",
            "fax_number": "301-791-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 MEMORIAL BLVD W",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406219",
            "telephone_number": "301-791-7060",
            "fax_number": "301-791-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEJ MED PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "OBIDI",
        "authorized_official_first_name": "CHUKUEMEKA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-791-7060",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Partners in Pediatrics and Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.