NPIMap

Organization Active NPI

Rooted Healthcare, LLC

  • Primary Care Nurse Practitioner
  • Westminster, MD
National Provider Identifier
1891576591
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
ROOTED HEALTHCARE, LLC
Practice address
1106 Business Pkwy S Ste B
Westminster, MD 21157-3054
Phone
(410) 751-7771
NPI assigned
Oct 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Kisun Devon Peters-Diaz
Title
Executive Director
Phone
(917) 861-2531

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Laboratory Director (Non-physician)Group: 193200000X MULTI-SPECIALTY GROUP 247ZC0005X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

1106 Business Pkwy S Ste B
Westminster, MD 21157-3054

Mailing address

405 N Center St Ste 25
Westminster, MD 21157-5126
Phone (917) 861-2531

National Provider Directory

National Provider Directory

Locations

7610 Main St
Fl 2
Sykesville, MD 21784

Practitioners & affiliated clinicians

Practitioners 5

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": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1891576591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N CENTER ST STE 25",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211575126",
            "telephone_number": "917-861-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 BUSINESS PKWY S STE B",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211573054",
            "telephone_number": "410-751-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTED HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "PETERS-DIAZ",
        "authorized_official_first_name": "KISUN",
        "authorized_official_middle_name": "DEVON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "917-861-2531"
    },
    "taxonomies": [
        {
            "code": "247ZC0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; 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.