NPIMap

Organization Active NPI

Erickson Health Medical Group of Maryland, PC

  • Clinical Social Worker
  • Catonsville, MD
National Provider Identifier
1972114403
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
ERICKSON HEALTH MEDICAL GROUP OF MARYLAND, PC
Practice address
711 Maiden Choice LN
Catonsville, MD 21228-3632
Phone
(410) 247-5602
Fax
(410) 242-1756
NPI assigned
Aug 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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

Authorized official

Name
Donna Ethel Rachuba
Title
Medical Staff Services Director
Phone
(410) 402-2258

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

711 Maiden Choice LN
Catonsville, MD 21228-3632

Mailing address

PO Box 783712
Philadelphia, PA 19178-3712
Phone (800) 360-3851

National Provider Directory

National Provider Directory
Tax ID family
Erickson HLTH Med GRP of MD6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1597017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597017600000",
    "number": "1972114403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 783712",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191783712",
            "telephone_number": "800-360-3851",
            "fax_number": "410-402-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 MAIDEN CHOICE LN",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212283632",
            "telephone_number": "410-247-5602",
            "fax_number": "410-242-1756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON HEALTH MEDICAL GROUP OF MARYLAND, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A",
        "authorized_official_last_name": "RACHUBA",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "ETHEL",
        "authorized_official_title_or_position": "MEDICAL STAFF SERVICES DIRECTOR",
        "authorized_official_telephone_number": "410-402-2258"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Catonsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; 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.