Providence Health Services, Inc is a Physiological Laboratory (organization) practicing in Washington, District Of Columbia. The National Provider Identifier (NPI) is #1285208009, which was assigned on May 17, 2021, and the registration record was last updated on May 6, 2022. The practitioner's main practice location is at 1150 Varnum St Ne Ste 2, Washington, DC 20017-2104; the contact telephone number is 2028547560, and the fax number is 2028547951. The primary taxonomy of Providence Health Services, Inc is Physiological Laboratory (293D00000X). The authorized official for Providence Health Services, Inc is Michael Dunwell (Coord Credentialing).
A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.
| NPI | 1285208009 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SERVICES, INC |
| Provider Name | PROVIDENCE HEALTH SERVICES, INC |
| Other Organization Name |
THE PROVIDENCE DIAGNOSTIC IMAGING CENTER (Doing Business As Name) |
| Other Name | THE PROVIDENCE DIAGNOSTIC IMAGING CENTER |
| Practice Address |
1150 Varnum St Ne Ste 2 Washington DC 20017-2104 |
| Practice Telephone | 2028547560 |
| Practice Fax Number | 2028547951 |
| Mailing Address |
1150 Varnum St Ne Washington DC 20017-2104 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2028547825 |
| Certification Date | 2022-05-06 |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2022-05-06 |
| Is Organization Subpart | N |
| Official Name | MICHAEL DUNWELL |
| Official Title | COORD CREDENTIALING |
| Telephone | 2028544069 |
| Primary | Code | Classification | Specialization | Taxonomy Group | License Number | License State |
|---|---|---|---|---|---|---|
| N | 261QM1200X | Clinic/Center | Magnetic Resonance Imaging (MRI) | |||
| N | 261QR0200X | Clinic/Center | Radiology | |||
| N | 261QR0206X | Clinic/Center | Radiology, Mammography | |||
| Y | 293D00000X | Physiological Laboratory | ||||
| N | 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Other Organization Name | Type |
|---|---|
| The Providence Diagnostic Imaging Center | Doing Business As Name |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Providence Health Services, Inc | 128 M St Nw, Washington, DC 20001-1205 | Family Medicine Physician | 2011-12-09 |
| Providence Health Services, Inc · Phs Outpatient Behavioral Health | 1140 Varnum St Ne Ste 100, Washington, DC 20017 | Counselor | 2008-07-18 |
| Providence Health Services, Inc · Phs Anesthesia | 1150 Varnum St Ne, Washington, DC 20017-2104 | Anesthesiology Physician | 2017-12-06 |
| Providence Health Services, Inc · The Providence Diagnostic Imaging Center | 1150 Varnum St Ne Ste 1, Washington, DC 20017-2104 | Magnetic Resonance Imaging (MRI) Clinic/Center | 2019-09-03 |
| Providence Health Services, Inc · Phs Gyn Group | 1150 Varnum St Ne, St Catherine's Hall, 2nd Floor, Washington, DC 20017-2107 | Gynecology Physician | 2017-09-26 |
| Providence Health Services, Inc · Phs Cardiology | 1150 Varnum St Ne Ste 300, Washington, DC 20017-2180 | Specialist | 2018-01-12 |
| Providence Health Services, Inc · Phs Occupational Health/Wellness | 1150 Varnum St Ne, Washington, DC 20017-2104 | Occupational Medicine Clinic/Center | 2017-11-17 |
| Providence Health Services, Inc · Phs Unity Healthcare Parkside Radiology | 765 Kenilworth Ter Ne, Washington, DC 20019-1898 | Radiology Clinic/Center | 2017-10-17 |
| Providence Health Services, Inc | 1160 Varnum St Ne, Depaul 312, Washington, DC 20017-2107 | Sports Medicine (Orthopaedic Surgery) Physician | 2013-11-27 |
| Providence Health Services, Inc · Phs Otolaryngology Pmb200 | 1140 Varnum St Ne, Pmb 200, Washington, DC 20017-2151 | Otolaryngology Physician | 2011-12-13 |
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| Code | 293D00000X |
| Taxonomy | Physiological Laboratory |
| Classification | Physiological Laboratory |
| Grouping | Laboratories |
| Definition: A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| Code | 261QM1200X |
| Taxonomy | Magnetic Resonance Imaging (MRI) Clinic/Center |
| Classification | Clinic/Center |
| Specialization | Magnetic Resonance Imaging (MRI) |
| Grouping | Ambulatory Health Care Facilities |
| Definition: Definition to come... |
| Code | 261QR0200X |
| Taxonomy | Radiology Clinic/Center |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Grouping | Ambulatory Health Care Facilities |
| Definition: Definition to come... |
| Code | 261QR0206X |
| Taxonomy | Mammography Clinic/Center |
| Classification | Clinic/Center |
| Specialization | Radiology, Mammography |
| Grouping | Ambulatory Health Care Facilities |
| Definition: Definition to come... |
| Code | 335V00000X |
| Taxonomy | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Classification | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Grouping | Suppliers |
| Definition: A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified] |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Cardiotech Diagnostics LLC | 42 Clarewood Dr, Hastings On Hudson, NY 10706-3637 | Physiological Laboratory | 2023-12-07 |
| Dayspring Auxiliary Services, LLC. | 965 S Highway 25 W, Williamsburg, KY 40769-1608 | Physiological Laboratory | 2024-02-14 |
| Shymiral Barnes | 3900 Lakeland Dr Ste 200, Flowood, MS 39232-8853 | Physiological Laboratory | 2024-03-12 |
| Elite Ultrasound Imaging I LLC | 6035 Peachtree Rd Ste C218, Doraville, GA 30360-3240 | Physiological Laboratory | 2023-10-02 |
| Ohi West Medical Group II LLC · Florida Medical Clinic Orlando Health Sleep Lab | 6233 Abbott Station Dr, Zephyrhills, FL 33542-4819 | Physiological Laboratory | 2024-01-11 |
| American Foundation for Biological Research | 9410 Key West Ave, Rockville, MD 20850-3345 | Physiological Laboratory | 2023-10-26 |
| Integris Neuro LLC | 2016 W Gore Blvd Ste 1, Lawton, OK 73501-3628 | Physiological Laboratory | 2023-09-13 |
| Cardiologx Diagnostic Solutions LLC | 9319 Lyndon B Johnson Fwy Ste 204, Dallas, TX 75243-3453 | Physiological Laboratory | 2023-08-09 |
| Btdi Jv, LLP · Touchstone Imaging Allen | 880 W Exchange Pkwy Ste 2100, Allen, TX 75013-1202 | Physiological Laboratory | 2023-09-27 |
| Dolphin Diagnostic Solutions LLC | 3475 W Alton Gloor Blvd Ste D, Brownsville, TX 78520-4475 | Physiological Laboratory | 2023-08-08 |
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| Street Address |
1150 VARNUM ST NE STE 2 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2104 |
| Country | US |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Cep America - Anesthesia PC | 1150 Varnum St Ne, Washington, DC 20017-2104 | Anesthesiology Physician | 2017-09-08 |
| Domenic Derobertis | 1150 Varnum St Ne, Washington, DC 20017-2104 | Anesthesiologist Assistant | 2017-05-15 |
| Jenny Lee | 1150 Varnum St Ne, Washington, DC 20017-2104 | Anesthesiologist Assistant | 2017-05-15 |
| Providence Health Services, Inc · The Providence Diagnostic Imaging Center | 1150 Varnum St Ne Ste 1, Washington, DC 20017-2104 | Magnetic Resonance Imaging (MRI) Clinic/Center | 2019-09-03 |
| Cep America - Anesthesia, PC | 1150 Varnum St Ne, Washington, DC 20017-2104 | Certified Registered Nurse Anesthetist | 2016-09-06 |
| Arthur Ke Jr. | 1150 Varnum Street, Ne, Washington, DC 20017-2104 | Anesthesiologist Assistant | 2015-02-25 |
| Cep America - Anesthesia PC | 1150 Varnum St Ne, Washington, DC 20017-2104 | Anesthesiology Physician | 2016-05-26 |
| Chinedu Emezue | 1615 Rhode Island Ave, Washington, DC 20017-2104 | Case Manager/Care Coordinator | 2022-11-18 |
| Cep America - Anesthesia, PC | 1150 Varnum St Ne, Washington, DC 20017-2104 | Certified Registered Nurse Anesthetist | 2016-10-14 |
| Roblesse Raphaelle Pamela Deugoue | 1150 Varnum St Ne, Washington, DC 20017-2104 | Behavior Technician | 2022-11-22 |
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| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Javalin Singh | Hsc Pediatric Center 1731 Bunker Hill Rd, Washington, DC 20017 | Home Health Aide | 2017-07-13 |
| Jemeka Samuels | 2412 Minnesota Ave Ne, Washington, DC 20017 | Social Worker | 2023-02-15 |
| Jimmie W Hamilton IIi | 1227 Emerson St Ne, Washington, DC 20017 | Behavior Technician | 2023-04-26 |
| Carolin Hernandez | 3814 12th St. Ne, Washington, DC 20017 | Behavior Technician | 2021-08-10 |
| Kristen Jones | 1140 Varnum St Ne, Pmb 203, Washington, DC 20017 | Physician Assistant | 2016-02-29 |
| Liliana Tatum | 1428 Hamlin Street Ne, Washington, DC 20017 | Professional Counselor | 2017-03-27 |
| Beyond Light · Behavioral Health -Substance Abuse | 1030 Kearny St Ne, Washington, DC 20017 | Community/Behavioral Health Agency | 2018-04-26 |
| Marie Hortense Mabou Sando | 1416 9th Street Nwdc, Washington, DC 20017 | Home Health Aide | 2016-08-10 |
| Bria Mathis | 10001 Lawrence St Ne, Washington, DC 20017 | Clinical Social Worker | 2022-01-17 |
| Specialized Education of Dc, Inc. · High Road School | 711-A Edgewood Street, Ne, Washington, DC 20017 | Local Education Agency (LEA) | 2015-10-08 |
| Find all providers in the same zip code | |||
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Providence Health & Services-Wa · Providence Regional Medical Center- Everett Employee Health & Wellness | 1330 Rockefeller, Suite 200, Everett, WA 98201-1677 | Acute Care Nurse Practitioner | 2010-01-22 |
| Providence Health & Services Washington · Providence Kodiak Island Medical Center | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | Skilled Nursing Facility | 2006-09-12 |
| Providence Health & Services Washington · Providence Kodiak Island Medical Center | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | Nursing Facility/Intermediate Care Facility | 2007-05-14 |
| Providence Health & Services - Washington · Providence Kodiak Island Medical Center | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | Skilled Nursing Facility | 2006-09-12 |
| Providence Health & Services Oregon · Providence Seaside Hospital, Providence Cannon Beach Clinic | 171 N Larch St Ste 16, Cannon Beach, OR 97110-3103 | Family Medicine Physician | 2019-02-15 |
| Providence Health & Services Wa · Providence St. Mary Medical Center Outpatient Pharmacy | 401 W Poplar St, Pharmacy, Walla Walla, WA 99362-2846 | Clinic Pharmacy | 2013-06-19 |
| Providence Health & Services Oregon · Providence Seaside Hospital, Providence Warrenton Clinic | 171 S Highway 101, Warrenton, OR 97146 | Multi-Specialty Clinic/Center | 2017-05-08 |
| Providence Health & Services Oregon · Providence Willamette Falls Medical Center | 1500 Division St, Oregon City, OR 97045-1527 | Anesthesiology Physician | 2016-10-26 |
| Providence Health & Services - Washington · Providence St. Peter Chemical Dependency Center | 508 Quarter Eighth Street, Hoquiam, WA 98550 | Substance Use Disorder Rehabilitation Hospital Unit | 2006-12-21 |
| Providence Health & Services - Washington · Providence Medical Group Southeast Washington Imaging | 401 W Poplar Street, Pmg Se Wa Imaging, Walla Walla, WA 99362-2846 | Diagnostic Radiology Physician | 2008-10-10 |
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This dataset includes over five million health care providers who are assigned National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare & Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under Health Insurance Portability and Accountability Act (HIPAA). Each provider is registered with the NPI, full name, status, address, taxonomy, other identifiers, etc.
| Subject | Transparency and Disclosure |
| Jurisdiction | Federal |
| Data Provider | National Plan and Provider Enumeration System (NPPES), by the Centers for Medicare & Medicaid Services (CMS) |
| Source | download.cms.gov |
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers and all health plans and health care clearinghouses, who must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). All health care providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI. A HIPAA-covered entity is a health care provider that conducts certain transactions in electronic form, or a health care clearinghouse, or a health plan (including commercial plans, Medicare, and Medicaid). Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008. This dataset includes over five million health care providers (individuals and organizations) who are assigned NPI. The provider data elements are disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA), as listed in the NPPES Data Dissemination Notice (CMS-6060-N). The NPI final rules define the following elements which required to be disclosed as determined by Department of Health & Human Services (HHS): NPI, Entity Type, Provider Name, Credential, Business Mailing Address, Business Location Address, Healthcare Provider Taxonomy Code, Other Provider Identifier, Provider Enumeration Date, NPI Deactivation Date, Provider License Number, Authorized Official Name and Contact Information. |