NPIMap

Organization Active NPI

Phoegenesis, Inc

  • Community Health Clinic/Center
  • Baltimore, MD
National Provider Identifier
1871164517
Registry record updated Jul 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
PHOEGENESIS, INC
Practice address
1901 S Charles St
Baltimore, MD 21230-4867
Phone
(909) 576-2224
NPI assigned
Jul 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2021

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

Authorized official

Name
Mr. Charles Ellis, LCSW-CNPI 1215017009
Title
President
Phone
(909) 576-2224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

1901 S Charles St
Baltimore, MD 21230-4867

Mailing address

1901 S Charles St
Baltimore, MD 21230-4867
Phone (909) 576-2224

Other names 1

  • PhoeGenesis, Inc Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cellis@trailwaysmh.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1625356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625356800000",
    "number": "1871164517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212304867",
            "telephone_number": "909-576-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212304867",
            "telephone_number": "909-576-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEGENESIS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-04",
        "last_updated": "2021-07-04",
        "certification_date": "2021-07-04",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-576-2224",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cellis@trailwaysmh.com",
            "affiliation": "N",
            "endpointDescription": "Electronic Medical Record",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1901 S Charles St",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212304867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PhoeGenesis, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.