Individual provider Active NPI

Julian Sebastian Botta

  • Emergency Medicine Physician
  • Baltimore, MD
National Provider Identifier
1942732748
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
D0090080 Issued in MD
Practice address
1830 E Monument St # Md21287
Suite 6‐100
Baltimore, MD 21287-0020
Phone
(201) 645-3735
NPI assigned
Mar 30, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X D0090080 MD Primary

Addresses

Primary practice location

1830 E Monument St # Md21287
Suite 6‐100
Baltimore, MD 21287-0020

Mailing address

1310 Dickerson Rd
Teaneck, NJ 07666-2816
Phone (201) 645-3735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201215000451 MD Practitioner - Emergency Medicine 1153699897 Reassigns benefits to 2 organizations
I20230608001606 DC Practitioner - Emergency Medicine 1153699897 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0090080MDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Dec 1, 2020 Accepting new patients
Johns Hopkins University Emergency Medicine CurrentSince Dec 1, 2020 Accepting new patients
Johns Hopkins University Current Accepting new patients
Mep Health, LLC Emergency Medicine CurrentSince Aug 4, 2021 Accepting new patients

Locations

4940 Eastern Ave
Baltimore, MD 21224

12500 Willowbrook Rd
Cumberland, MD 21502
Phone (240) 964-1255

9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1942732748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 DICKERSON RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076662816",
            "telephone_number": "201-645-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 E MONUMENT ST # MD21287",
            "address_2": "SUITE 6‐100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870020",
            "telephone_number": "201-645-3735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTA",
        "first_name": "JULIAN",
        "middle_name": "SEBASTIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-30",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0090080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.