Jea Sub Song

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

S03824 Issued in MD

Practice address

3460 Ellicott Center Dr Ste 102
Ellicott City, MD 21043

Phone

(410) 465-3074

NPI assigned

Jun 24, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Health Solutions LLC

  • Chiropractor
  • Ellicott City, MD
  • NPI 1841763562
  Medicare reassignment NPD Authorized official
• Mercy Health Solutions LLC

  • Acupuncturist
  • Ellicott City, MD
  • NPI 1609545862
  NPD

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1942682174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10414 BRADDOCK RUN RD",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212201931",
            "telephone_number": "443-301-3191",
            "fax_number": "410-220-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 ELLICOTT CENTER DR STE 102",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "21043",
            "telephone_number": "410-465-3074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9192 Red Branch Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MD",
            "postal_code": "210452082",
            "country_code": "US",
            "telephone_number": "410-418-9000",
            "fax_number": "443-914-2377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "JEA SUB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-24",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MD",
            "license": "U02569",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S03824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olayinka Olamide Sogbesan
• Brenda Dela Cruz Solano, PT
• Solaris Group (solaris healthcare)
• Danielle Sollers, RN
• Jenna Sommers, LMT
• Young S Song, D.C.
• Tripti Soni, MD
• Bailey Ann Souder
• Michelle Louise Howard Soukiassian
• Jeffrey Soulen, M.D.

• Chiropractor in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Chiropractor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.