NPIMap

Organization Active NPI

Medical Home Development Group

  • Family Medicine Physician
  • Washington, DC
National Provider Identifier
1902232168
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDICAL HOME DEVELOPMENT GROUP
Practice address
2112 F St NW Ste 504
Washington, DC 20037-2761
Phone
(202) 684-2784
Fax
(866) 643-9237
NPI assigned
Sep 19, 2013
Last updated
Sep 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Authorized official

Name
Mrs. Audrey Whetsell, MS
Title
Ceo
Phone
(843) 412-5548

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Case Management Agency 251B00000X

Addresses

Primary practice location

2112 F St NW Ste 504
Washington, DC 20037-2761

Mailing address

4975 Lacross Rd
Suite 151
N Charleston, SC 29406-6523
Phone (843) 412-5548

Other identifiers 1

IdentifierTypeStateIssuer
086030300MedicaidDC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150928000962 DC Part B Supplier - Clinic/Group Practice 0244468114 Receives reassigned benefits from 14 practitioners
Practice locations: Washington, DC

National Provider Directory

National Provider Directory

Locations

4228 Wisconsin Ave NW
Ste A
Washington, DC 20016
Phone (202) 684-2784

4228 Wisconsin Ave NW
Ste A1
Washington, DC 20016

2430 Mall Dr
Ste 260
North Charleston, SC 29406

4975 Lacross Rd
Ste 151
North Charleston, SC 29406

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1902232168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4975 LACROSS RD",
            "address_2": "SUITE 151",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294066523",
            "telephone_number": "843-412-5548",
            "fax_number": "866-643-9237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 F ST NW STE 504",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200372761",
            "telephone_number": "202-684-2784",
            "fax_number": "866-643-9237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL HOME DEVELOPMENT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "WHETSELL",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-412-5548",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086030300",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.