Individual provider Active NPI

Marilyn Bisanga Dzati

  • Nurse Practitioner
  • Bowie, MD
National Provider Identifier
1962762351
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP1041682 Issued in DC
Practice address
14304 Driftwood Rd
Bowie, MD 20721-3044
Phone
(240) 468-5873
NPI assigned
May 21, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R224845 MD
Home Health Aide 374U00000X B-252-585-009-027 MD
Nurse Practitioner 363L00000X NP1041682 DC Primary

Addresses

Primary practice location

14304 Driftwood Rd
Bowie, MD 20721-3044

Mailing address

14304 Driftwood Rd
Bowie, MD 20721-3044
Phone (240) 468-5873

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231106003231 DC Practitioner - Nurse Practitioner 6305293879 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
A and M Wellness ResourcesGroup PAC ID 3274062609, 2 clinicians

Practice addresses (Care Compare)

712 H St NE
Washington, DC 20002-3627
Phone (240) 468-5873

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP1041682DCMDNurse Practitioner
R224845MDMDPsychiatric/Mental Health Nurse Practitioner
B-252-585-009-027MDMDHome Health Aide

Practice roles

OrganizationSpecialtyStatusNew patients
Absolute Healthcare Resources, LLC CurrentSince Feb 14, 2024 Accepting new patients
A & M Wellness Resources Psychiatric/Mental Health CurrentSince Dec 28, 2024 Accepting new patients
Terra Health Care LLC CurrentSince Sep 23, 2023 Accepting new patients

Locations

1039 Bladensburg Rd NE
Washington, DC 20002
Phone (202) 507-8139

712 H St NE
Washington, DC 20002
Phone (240) 559-4010

Organizations & group practices 3

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": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1962762351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14304 DRIFTWOOD RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207213044",
            "telephone_number": "240-468-5873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14304 DRIFTWOOD RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207213044",
            "telephone_number": "240-468-5873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZATI",
        "first_name": "MARILYN",
        "middle_name": "BISANGA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-21",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R224845",
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "MD",
            "license": "B-252-585-009-027",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DC",
            "license": "NP1041682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

Verify at the official NPI Registry.