NPI Code Detail JSON Logo

1811709561 NPI number — KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

NPI Number: 1811709561
Health Care Provider/Practitioner: KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

Information about “1811709561” NPI (KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC) exists in 1811709561 in HTML format HTML  |  1811709561 in plain Text format TXT  |  1811709561 in PDF (Portable Document Format) PDF  |  1811709561 in an XML format XML  formats.

NPI Number : 1811709561 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811709561",
    "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": "6",
    "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": "8008 WESTPARK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MC LEAN",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22102-3109",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-816-2424",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/21/2025",
    "LastUpdateDate": "10/10/2025",
    "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": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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