NPIMap

Organization Active NPI

Vitality NP Group

  • Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1912574500
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
VITALITY NP GROUP
Practice address
6617 Pebble Brooke Rd
Baltimore, MD 21209-3793
Phone
(732) 486-7373
NPI assigned
Jun 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Ettie Tress
Title
Admin
Phone
(732) 486-7373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

6617 Pebble Brooke Rd
Baltimore, MD 21209-3793

Mailing address

685 River Ave Unit 3
Lakewood, NJ 08701-5288
Phone (732) 486-7373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220314001957 MD Part B Supplier - Clinic/Group Practice 0345635157 Receives reassigned benefits from 6 practitioners
Practice locations: Baltimore, MD
O20220815000569 DC Part B Supplier - Clinic/Group Practice 0345635157 Receives reassigned benefits from 2 practitioners
Practice locations: Rockville, MD

National Provider Directory

National Provider Directory

Locations

456 Chestnut St
Unit 102
Lakewood, NJ 08701

Practitioners & affiliated clinicians

Practitioners 7

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": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1912574500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 RIVER AVE UNIT 3",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015288",
            "telephone_number": "732-486-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6617 PEBBLE BROOKE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093793",
            "telephone_number": "732-486-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY NP GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "TRESS",
        "authorized_official_first_name": "ETTIE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "732-486-7373"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Feb 17, 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.