NPIMap

Organization Active NPI

La Plata Pediatrics & Family Health, LLC

  • Health Service Clinic/Center
  • La Plata, MD
National Provider Identifier
1891001996
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
R162903 Issued in MD
Legal business name
LA PLATA PEDIATRICS & FAMILY HEALTH, LLC
Practice address
103 Centennial St
Suite B
La Plata, MD 20646-5984
Phone
(301) 643-8127
NPI assigned
Aug 26, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Authorized official

Name
Jamie Reidy, CRNPNPI 1508185505
Title
Owner and Nurse Practitioner
Phone
(013) 934-9111

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Health Service Clinic/Center 261QH0100X R162903 MD Primary
Medical Specialty Clinic/Center 261QM2500X R162903 MD

Addresses

Primary practice location

103 Centennial St
Suite B
La Plata, MD 20646-5984

Mailing address

103 Centennial St Ste B
La Plata, MD 20646-5985
Phone (301) 934-9111

Other identifiers 1

IdentifierTypeStateIssuer
033338700MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110106000662 MD Part B Supplier - Clinic/Group Practice 8022207059 Receives reassigned benefits from 10 practitioners
Practice locations: La Plata, MD

National Provider Directory

National Provider Directory

Locations

103 Centennial St
Ste B
La Plata, MD 20646
Phone (301) 200-3032

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 12

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": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1891001996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CENTENNIAL ST STE B",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465985",
            "telephone_number": "301-934-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CENTENNIAL ST",
            "address_2": "SUITE B",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465984",
            "telephone_number": "301-643-8127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PLATA PEDIATRICS & FAMILY HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-26",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "REIDY",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "OWNER AND NURSE PRACTITIONER",
        "authorized_official_telephone_number": "013-934-9111",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MD",
            "license": "R162903",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MD",
            "license": "R162903",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033338700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.