NPIMap

Organization Active NPI

Providence Health Services, Inc

Doing business as PHS GYN Group

  • Gynecology Physician
  • Washington, DC
National Provider Identifier
1972012615
Registry record updated Oct 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
HFD01-0212 Issued in DC
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Doing business as
PHS GYN Group
Practice address
1150 Varnum St NE
St Catherine's Hall, 2ND Floor
Washington, DC 20017-2107
Phone
(202) 854-7074
Fax
(202) 854-7470
NPI assigned
Sep 26, 2017
Last updated
Oct 11, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2017

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

Authorized official

Name
Beau Higginbothan
Title
Vice President/Coo
Phone
(410) 368-3162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X HFD01-0212 DC Primary

Addresses

Primary practice location

1150 Varnum St NE
St Catherine's Hall, 2ND Floor
Washington, DC 20017-2107

Mailing address

1160 Varnum St NE Ste 102
Washington, DC 20017-2106
Phone (202) 854-4069

Other names 1

  • PHS GYN GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PHS-Emergency Room Serv18 organizations share this tax ID, including this one
Part of
PHS Sleep Disorders Institute

Other organizations with this tax ID 17

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

View all 17

Locations

1150 Varnum St NE
Fl 2
Washington, DC 20017
Phone (202) 269-7074

1160 Varnum St NE
Ste 102
Washington, DC 20017

Practitioners & affiliated clinicians

Practitioners 2

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": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507680000000",
    "number": "1972012615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 VARNUM ST NE STE 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172106",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST CATHERINE'S HALL, 2ND FLOOR",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-854-7074",
            "fax_number": "202-854-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2017-09-26",
        "last_updated": "2017-10-11",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "410-368-3162"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS GYN GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.