Organization Active NPI

Triibe Medical LLC

  • Family Medicine Physician
  • Largo, MD
National Provider Identifier
1962047159
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRIIBE MEDICAL LLC
Practice address
9500 Medical Center Dr Ste 105
Largo, MD 20774-3703
Phone
(301) 615-4133
Fax
(240) 245-2918
NPI assigned
Nov 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Uloma C Ibe, MDNPI 1649667940
Title
Owner
Phone
(202) 704-3010

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

9500 Medical Center Dr Ste 105
Largo, MD 20774-3703

Mailing address

PO Box 27996
Belfast, ME 04915-2031
Phone (301) 615-4133

Other identifiers 1

IdentifierTypeStateIssuer
585019301MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200415000086 DC Part B Supplier - Clinic/Group Practice 2163852161 Receives reassigned benefits from 2 practitioners
Practice locations: Largo, MD

National Provider Directory

National Provider Directory

Locations

9200 Corporate Blvd
Ste 120
Rockville, MD 20850

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22336/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1962047159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27996",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152031",
            "telephone_number": "301-615-4133",
            "fax_number": "240-245-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MEDICAL CENTER DR STE 105",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207743703",
            "telephone_number": "301-615-4133",
            "fax_number": "240-245-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIIBE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "IBE",
        "authorized_official_first_name": "ULOMA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "202-704-3010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "585019301",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.