NPIMap

Individual provider Active NPI

Sean Tackett, M.D.

  • Hospitalist Physician
  • Baltimore, MD
National Provider Identifier
1881910420
Registry record updated Aug 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
D75353 Issued in MD
Practice address
4940 Eastern Ave
B-1 Room 114D
Baltimore, MD 21224-2735
Phone
(410) 550-3350
Fax
(410) 550-0491
NPI assigned
Apr 7, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D75353 MD
Hospitalist Physician 208M00000X D75353 MD Primary

Addresses

Primary practice location

4940 Eastern Ave
B-1 Room 114D
Baltimore, MD 21224-2735

Mailing address

824 S Bond St
Apt B
Baltimore, MD 21231-3306
Phone (412) 370-8610

Other identifiers 1

IdentifierTypeStateIssuer
067065100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130729000089 MD Practitioner - HospitalistPractitioner - Internal Medicine 3072762244 Reassigns benefits to 3 organizations
I20160727000679 DC Practitioner - HospitalistPractitioner - Internal Medicine 3072762244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
University of Pittsburgh School of Medicine, 2010
Medicare assignment
May accept Medicare assignment
Group practices
Johns Hopkins UniversityGroup PAC ID 8921903147, 2,886 clinicians

Practice addresses (Care Compare)

1000 E Eager St
E Baltimore Med Ctr
Baltimore, MD 21202-5533
Phone (410) 522-9800

4940 Eastern Ave
Baltimore, MD 21224-2735
Phone (410) 550-0100

5601 Lloch Raven Blvd
Baltimore, MD 21239-2945
Phone (443) 444-4714

5755 Cedar LN
Columbia, MD 21044-2912
Phone (410) 884-4644

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University Current Accepting new patients
Greater Baltimore Medical Center, Inc. CurrentSince Jun 3, 2019 Accepting new patients
Johns Hopkins Community Physicians, Inc Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Greater Baltimore Medical Center, Inc Current Accepting new patients
Johns Hopkins University CurrentSince Jul 1, 2013 Accepting new patients
Johns Hopkins University CurrentSince Jul 1, 2013 Accepting new patients
Johns Hopkins Community Physicians Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Greater Baltimore Medical Center, Inc. Internal Medicine CurrentSince Jun 3, 2019 Accepting new patients
Johns Hopkins Community Physicians, Inc Internal Medicine CurrentSince Jul 7, 2016 Accepting new patients
Johns Hopkins Bayview Medical Center Inc Past Accepting new patients

Locations

4940 Eastern Ave
Rm 114D
Baltimore, MD 21224
Phone (410) 550-3350

5601 Loch Raven Blvd
Baltimore, MD 21239
Phone (443) 444-4714

1000 E Eager St
Baltimore, MD 21202
Phone (410) 522-9800

14207 Park Center Dr
Ste 102
Laurel, MD 20707
Phone (301) 604-5254

6565 N Charles St
Ste 203
Towson, MD 21204
Phone (410) 828-3760

6569 N Charles St
Ste 505
Towson, MD 21204
Phone (443) 849-2196

Interoperability endpoints

  • Direct secure messaging: stackett9985@direct.hopkinsmedicine.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503619200000",
    "number": "1881910420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 S BOND ST",
            "address_2": "APT B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212313306",
            "telephone_number": "412-370-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 EASTERN AVE",
            "address_2": "B-1 ROOM 114D",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242735",
            "telephone_number": "410-550-3350",
            "fax_number": "410-550-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "SEAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2017-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D75353",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MD",
            "license": "D75353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067065100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.