NPI |
1619485539 |
The first name of the authorized official. |
Entity Type Code |
1 |
The title or position of the authorized official. |
Provider Last Name Legal Name |
RICHARDSON |
The 10-position telephone number of the authorized official. |
Provider First Name |
ROXANNE |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Middle Name |
WILLIAMS |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Credential Text |
VISION TEACHER |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider First Line Business Practice Location Address |
8757 GEORGIA AVE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
SILVER SPRING |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MD |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
209103737 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2407375100 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
2407375100 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
1/12/2018 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
1/12/2018 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
2255R0406X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
DC |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|