PHS FAMILY MEDICINE & PEDIATRICS PMB103 (NPI# 1750659272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750659272 |
| Entity Type | Organization |
| Organization Name | PHS FAMILY MEDICINE & PEDIATRICS PMB103 |
| Other Organization Name | PROVIDENCE HEALTH SERVICES |
| Practice Address |
1140 Varnum St Ne Pmb103 Washington DC 20017-2151 |
| Mailing Address |
1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 |
| Practice Telephone | 2028547074 |
| Practice Fax Number | 2028547470 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2028547825 |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2016-09-06 |
| Authorized Official Name | MR. CHARLES F HABERKERN (VP) |
| Authorized Official Telephone | 2028544255 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| N | 282N00000X | General Acute Care Hospital | HFD01-0212 | DC | Hospitals |
| Y | 207Q00000X | Family Medicine | HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 09810714 | 05 | |
| MD | 005145100 | 05 | |
| DC | 029833400 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Health Services | Other Name - Individual/Organization |
| Street Address |
1140 VARNUM ST NE PMB103 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194725184 | Gail S Kerr | Internal Medicine | 1140 Varnum St Ne, Suite #201, Washington, DC 20017-2151 | 2005-07-31 |
| 1144641713 | Capital Consulting Services, LLC | Internal Medicine | 1140 Varnum St Ne, Pmb 105, Washington, DC 20017-2151 | 2013-12-26 |
| 1457693012 | Phs Medical Specialists Pmb107 | General Acute Care Hospital | 1140 Varnum St Ne, Pmb107, Washington, DC 20017-2151 | 2013-03-21 |
| 1710240114 | Dal Yoo Md LLC | Internal Medicine | 1140 Varnum St Ne, Suite 102, Washington, DC 20017-2151 | 2012-06-20 |
| 1366710766 | Providence Health Services, Inc | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 200, Washington, DC 20017-2151 | 2011-12-13 |
| 1326316936 | Phs Internal Medicine Pmb202 | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 202, Washington, DC 20017-2151 | 2011-12-09 |
| 1457666000 | Nana Yaw Asamoah-mensah, M.d.,p.c. | Psychiatry & Neurology | 1140 Varnum St Ne, Suite 205, Washington, DC 20017-2153 | 2010-08-06 |
| 1730492422 | Andre S Michalak Md PC | Clinic/Center | 1140 Varnum St Ne, Suite 208b, Washington, DC 20017-2151 | 2010-07-22 |
| 1922335561 | Bustos & Associates, LLC | Preferred Provider Organization | 1140 Varnum St Ne, Pmb 105, Washington, DC 20017-2151 | 2009-11-03 |
| 1740415264 | Mikel Anne Hofmann | Family Medicine | 1140 Varnum St Ne, Ste 200, Washington, DC 20017-2153 | 2009-05-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588215479 | Janet Achankeng Folem | Psychologist | 7100 Varnum St Ne, Suit 218, Washington, DC 20017 | 2019-09-23 |
| 1013475284 | Raphaelia Agnes Johnson-phillips | Technician | 440 Taylor St. Ne Building B Apt 22, Washington Dc, DC 20017 | 2019-03-06 |
| 1528551413 | Harpreet Saluja | Student in an Organized Health Care Education/Training Program | 1150 Varnum St Ne, Providence Hospital Im Department, Washington, DC 20017 | 2018-06-14 |
| 1134638042 | Jane Hayashi-kim | Speech-Language Pathologist | 3910 9th St Ne, Apartment 3, Washington, DC 20017 | 2017-09-22 |
| 1346766102 | Aaliyah Gabrielle Jones | Technician | 611edgewood Ne, Washington, DC 20017 | 2017-08-14 |
| 1417479197 | Javalin Singh | Home Health Aide | Hsc Pediatric Center 1731 Bunker Hill Rd, Washington, DC 20017 | 2017-07-13 |
| 1386174175 | Genevieve Wells | Home Health Aide | 601 Edgewood St. Ne, Apt 706, Washington, DC 20017 | 2017-06-14 |
| 1487183810 | Valerie Anne Pierre | Student in an Organized Health Care Education/Training Program | 1150 Varnum Street, N.e., Acc 209, Washington, DC 20017 | 2017-06-08 |
| 1639600984 | Liliana Tatum | Counselor | 1428 Hamlin Street Ne, Washington, DC 20017 | 2017-03-27 |
| 1750835435 | Marie Hortense Mabou Sando | Home Health Aide | 1416 9th Street Nwdc, Washington, DC 20017 | 2016-08-10 |
| Find all providers in zip 20017 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598314908 | Centerville Clinics Inc | Family Medicine | Centerville Clinics - City Mission Site, 84 W Wheeling Street, Washington, PA 15301-6918 | 2019-09-09 |
| 1912487380 | James Elwood Richardson | Family Medicine | 270 Shady Ln, Washington, PA 15301-2536 | 2018-08-15 |
| 1851829709 | Jason Snavely | Family Medicine | 95 Leonard Ave Bldg 22nd, Washington, PA 15301-3368 | 2017-05-23 |
| 1760923361 | Natasha Khawaja | Family Medicine | Upper Cardozo Community Health Center, 320 14th Street Nw, Washington, DC 20009 | 2017-03-15 |
| 1992158364 | Ok Hee Rhee | Family Medicine | 6 Club House Dr Ste 102, Washington, NJ 07882-2213 | 2016-07-20 |
| 1154738193 | Presidential Healthcare Center | Family Medicine | 5215 Loughboro Road Nw, Suite 470, Washington, DC 20016 | 2014-07-22 |
| 1174936686 | Andrew Moss | Family Medicine | 6121 32nd St Nw, Washington, DC 20015-2459 | 2014-06-03 |
| 1417367814 | Fri Awasum | Family Medicine | 2041 Georgia Ave Nw Faclty Practice Plan Suite 3200, Washington, DC 20060-7232 | 2014-05-07 |
| 1982024378 | Robert Latham Baillieu | Family Medicine | 1400 I (eye) Street Nw, Suite 825, Washington, DC 20005 | 2014-04-24 |
| 1003233453 | Jennifer Carlton | Family Medicine | 64580 Van Dyke Rd Ste C, Washington, MI 48095-2811 | 2014-03-24 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20017 |
Please comment or provide details below to improve the information on PHS FAMILY MEDICINE & PEDIATRICS PMB103.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.