NPIMap

Organization Active NPI

Citywide Behavioral Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1881100857
Registry record updated Dec 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
CITYWIDE BEHAVIORAL HEALTH
Practice address
17 Warren Rd Ste 20B
Baltimore, MD 21208-5334
Phone
(410) 929-2314
Fax
(410) 484-8107
NPI assigned
Dec 28, 2017
Last updated
Dec 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2017

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

Authorized official

Name
Pamela Johnson, CRNPNPI 1023252129
Title
Owner
Phone
(410) 274-8688

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist 364SP0807X

Addresses

Primary practice location

17 Warren Rd Ste 20B
Baltimore, MD 21208-5334

Mailing address

17 Warren Rd Ste 20B
Baltimore, MD 21208-5334
Phone (410) 929-2314

Other names 1

  • Citywide Health Corporation Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180524000072 MD Part B Supplier - Clinic/Group Practice 6608131594 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Baltimore, MD

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Citywide Behavioral Health11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

17 Warren Rd
Ste 20B
Pikesville, MD 21208
Phone (410) 484-0036

Practitioners & affiliated clinicians

Practitioners 2

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": "1514419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514419200000",
    "number": "1881100857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 20B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085334",
            "telephone_number": "410-929-2314",
            "fax_number": "410-484-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 20B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085334",
            "telephone_number": "410-929-2314",
            "fax_number": "410-484-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITYWIDE BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-28",
        "last_updated": "2017-12-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-274-8688",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0807X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citywide Health Corporation",
            "code": "5",
            "type": "Other 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 Dec 28, 2017; 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.