NPIMap

Organization Active NPI

Advance Integrated Health, LLC

  • Multi-Specialty Clinic/Center
  • Bowie, MD
National Provider Identifier
1952934671
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ADVANCE INTEGRATED HEALTH, LLC
Practice address
16204 Penterra Way
Bowie, MD 20716-1919
Phone
(301) 978-1990
NPI assigned
Feb 20, 2020
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Deborah Kesewah Koroma, CRNPNPI 1780982066
Title
Nurse Practitioner
Phone
(301) 978-1990

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Primary Care Clinic/Center 261QP2300X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

16204 Penterra Way
Bowie, MD 20716-1919

Mailing address

16204 Penterra Way
Bowie, MD 20716-1919
Phone (301) 978-1990

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201028002136 DC Part B Supplier - Clinic/Group Practice 4183043623 Receives reassigned benefits from 5 practitioners
Practice locations: Bowie, MD

National Provider Directory

National Provider Directory
Tax ID family
Advance Integrated Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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": "1582156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1952934671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16204 PENTERRA WAY",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161919",
            "telephone_number": "301-978-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16204 PENTERRA WAY",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161919",
            "telephone_number": "301-978-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE INTEGRATED HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-20",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "KOROMA",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "KESEWAH",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "301-978-1990",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.