NPIMap

Organization Active NPI

Elysium, LLC

Doing business as Elysium

  • Psychiatric/Mental Health Nurse Practitioner
  • Forest Hill, MD
National Provider Identifier
1871355305
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ELYSIUM, LLC
Doing business as
Elysium
Elysium Psychiatric Services
Practice address
210 Colgate Dr
Forest Hill, MD 21050-1343
Phone
(443) 243-3020
NPI assigned
Jan 30, 2024
Last updated
Jan 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Authorized official

Name
Robert BowenNPI 1073064176
Title
Owner
Phone
(443) 243-3020

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
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

210 Colgate Dr
Forest Hill, MD 21050-1343

Mailing address

210 Colgate Dr
Forest Hill, MD 21050-1343
Phone (443) 243-3020

Other names 2

  • Elysium Doing business as
  • Elysium Psychiatric Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240413000058 MD Part B Supplier - Clinic/Group Practice 3173962933 Receives reassigned benefits from 4 practitioners
Practice locations: Forest Hill, MD

National Provider Directory

National Provider Directory
Tax ID family
Elysium2 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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1871355305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 COLGATE DR",
            "city": "FOREST HILL",
            "state": "MD",
            "postal_code": "210501343",
            "telephone_number": "443-243-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 COLGATE DR",
            "city": "FOREST HILL",
            "state": "MD",
            "postal_code": "210501343",
            "telephone_number": "443-243-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELYSIUM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-243-3020"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elysium",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elysium Psychiatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Hill, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.