1003792037 NPI number — KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

NPI Number: 1003792037
Health Care Provider/Practitioner: KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

NPI Number : 1003792037 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003792037",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC.",
    "ParentOrgTIN": null,
    "OrgName": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4000 GARDEN CITY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HYATTSVILLE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20785-2418",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-816-2424",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13285 MINNIEVILLE RD STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODBRIDGE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22192-4018",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-986-2400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/14/2025",
    "LastUpdateDate": "10/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SWINTON",
    "AuthorizedOfficialFirstName": "COLLEEN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR, CREDENTIALING",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "301-257-2797",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QX0100X",
          "TaxonomyName": "Occupational Medicine Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}