NPIMap

Organization Active NPI

Sage Mental Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Frederick, MD
National Provider Identifier
1902475353
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SAGE MENTAL WELLNESS
Practice address
309 E Patrick St
Frederick, MD 21701-6792
Phone
(253) 355-5342
NPI assigned
Jun 21, 2021
Last updated
May 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Authorized official

Name
Audra WorthingtonNPI 1629685607
Title
Owner
Phone
(240) 310-9961

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
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

309 E Patrick St
Frederick, MD 21701-6792

Mailing address

250 Antietam Dr
Falling Waters, WV 25419-4880
Phone (253) 355-5342

Other practice location 1

1190 Mount Aetna Rd Ste 206
Hagerstown, MD 21740-6833
Phone (240) 310-9961

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220507000003 MD Part B Supplier - Clinic/Group Practice 6507254901 Receives reassigned benefits from 4 practitioners
Practice locations: Frederick, MD; Hagerstown, MD

National Provider Directory

National Provider Directory

Locations

1190 Mount Aetna Rd
Ste 206
Hagerstown, MD 21740
Phone (240) 310-9961

Interoperability endpoints

  • Direct secure messaging: sagemh@org57.direct.charmhealth.com

Practitioners & affiliated clinicians

Practitioners 5

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": "1624233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1902475353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 ANTIETAM DR",
            "city": "FALLING WATERS",
            "state": "WV",
            "postal_code": "254194880",
            "telephone_number": "253-355-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E PATRICK ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217016792",
            "telephone_number": "253-355-5342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1190 Mount Aetna Rd Ste 206",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217406833",
            "country_code": "US",
            "telephone_number": "240-310-9961",
            "fax_number": "877-793-1645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAGE MENTAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-21",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "WORTHINGTON",
        "authorized_official_first_name": "AUDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-310-9961"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.