NPIMap

Organization Active NPI

Jade Health & Wellness, LLC

  • Primary Care Clinic/Center
  • Baltimore, MD
National Provider Identifier
1902448335
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
JADE HEALTH & WELLNESS, LLC
Practice address
3301 Belair Rd
Baltimore, MD 21213-1257
Phone
(410) 929-3893
NPI assigned
Oct 17, 2019
Last updated
Sep 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Theressa Williams, CRNP, FNP-BCNPI 1922514348
Title
Executive Director/Ceo
Phone
(443) 744-6214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

3301 Belair Rd
Baltimore, MD 21213-1257

Mailing address

9627 Eaves Dr
Owings Mills, MD 21117-5919

Other practice location 1

9627 Eaves Dr
Owings Mills, MD 21117-5919
Phone (443) 744-6214

Other identifiers 1

IdentifierTypeStateIssuer
1922514348MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL computer

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1902448335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9627 EAVES DR",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 BELAIR RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212131257",
            "telephone_number": "410-929-3893"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9627 Eaves Dr",
            "address_purpose": "LOCATION",
            "city": "Owings Mills",
            "state": "MD",
            "postal_code": "211175919",
            "country_code": "US",
            "telephone_number": "443-744-6214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JADE HEALTH & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-17",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "THERESSA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "443-744-6214",
        "authorized_official_credential": "CRNP, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922514348",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "computer",
            "affiliation": "N",
            "address_1": "9627 Eaves Dr",
            "city": "Owings Mills",
            "state": "MD",
            "country_code": "US",
            "postal_code": "211175919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.