NPIMap

Organization Active NPI

Free State Health and Wellness, LLC

  • Family Nurse Practitioner
  • Crownsville, MD
National Provider Identifier
1902324130
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
FREE STATE HEALTH AND WELLNESS, LLC
Practice address
43 Community PL
Crownsville, MD 21032-2034
Phone
(440) 570-9428
NPI assigned
Sep 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Melissa Ward, CRNPNPI 1568848687
Title
Nurse Practitioner
Phone
(440) 570-9428

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

43 Community PL
Crownsville, MD 21032-2034

Mailing address

100 Middletown Pkwy Unit 202
Middletown, MD 21769-7767
Phone (240) 647-9049

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171019000109 MD Part B Supplier - Clinic/Group Practice 5294001210 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Nottingham, MD; Frederick, 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

Locations

5257 Buckeystown Pike
Frederick, MD 21704
Phone (240) 674-5485

100 Middletown Pkwy
Unit 202
Middletown, MD 21769
Phone (240) 934-0090

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 6

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": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1902324130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MIDDLETOWN PKWY UNIT 202",
            "city": "MIDDLETOWN",
            "state": "MD",
            "postal_code": "217697767",
            "telephone_number": "240-647-9049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 COMMUNITY PL",
            "city": "CROWNSVILLE",
            "state": "MD",
            "postal_code": "210322034",
            "telephone_number": "440-570-9428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE STATE HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "440-570-9428",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crownsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.