NPIMap

Organization Active NPI

Chesapeake Wellness Center

  • Addiction Medicine (Family Medicine) Physician
  • Elkton, MD
National Provider Identifier
1902494024
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
CHESAPEAKE WELLNESS CENTER
Practice address
105 E Main St
Elkton, MD 21921-5906
Phone
(410) 275-8156
Fax
(877) 433-6830
NPI assigned
Jan 5, 2021
Last updated
Jan 5, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CHESAPEAKE WELLNESS CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Authorized official

Name
Jane E Hyskell
Title
Credentialing Agent
Phone
(814) 938-8263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

105 E Main St
Elkton, MD 21921-5906

Mailing address

PO Box 669
Cecilton, MD 21913-0669
Phone (410) 275-8156

Other identifiers 1

IdentifierTypeStateIssuer
205409400MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pkatz@PMKD-MD.direct.office.nexgen.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Chesapeake Wellness Center6 organizations share this tax ID, including this one
Part of
Chesapeake Wellness Center

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: pkatz@pmkd-md.direct.office.nexgen.com

NPI Registry JSON

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1902494024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 669",
            "city": "CECILTON",
            "state": "MD",
            "postal_code": "219130669",
            "telephone_number": "410-275-8156",
            "fax_number": "877-433-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E MAIN ST",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215906",
            "telephone_number": "410-275-8156",
            "fax_number": "877-433-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHESAPEAKE WELLNESS CENTER",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2020-12-28",
        "status": "A",
        "authorized_official_last_name": "HYSKELL",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "814-938-8263"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205409400",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pkatz@PMKD-MD.direct.office.nexgen.com",
            "affiliation": "N",
            "endpointDescription": "PAUL KATZ",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMAIL",
            "address_1": "105 E MAIN ST",
            "city": "ELKTON",
            "state": "MD",
            "country_code": "US",
            "postal_code": "219215906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.