Basic Information
| Provider Information | |||||||||
| NPI: | 1386690790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HELIXCARE MEDICAL GROUP, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDSTAR PHYSICIAN PARTNERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 PULASKI PARK DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MIDDLE RIVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212201400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105743000 | ||||||||
| FaxNumber: | 4105742261 | ||||||||
| Practice Location | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | RUSSELL MORGAN BLDG., SUITE 206 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434445600 | ||||||||
| FaxNumber: | 4434444606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 09/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | STEELE-WHITE | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING ASSOCIATE | ||||||||
| AuthorizedOfficialTelephone: | 4109333073 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 366A | 01 | MD | CAREFIRST OF MD | OTHER | 511000933 | 05 | MD | MEDICAID | A732 | 01 | MD | CAREFIRST DC | OTHER | CC3132 | 01 | MD | RAILROAD MEDICARE | OTHER | W652 | 01 | MD | CAREFIRST DC | OTHER | W651 | 01 | MD | CAREFIRST DC | OTHER | W653 | 01 | MD | CAREFIRST DC | OTHER | 511000926 | 05 | MD | MEDICAID | W611 | 01 | MD | CAREFIRST DC | OTHER | W655 | 01 | MA | CAREFIRST DC | OTHER | 511000900 | 05 | MD | MEDICAID | 511000902 | 05 | MD | MEDICAID | 511000903 | 05 | MD | MEDICAID | KT80 | 01 | MD | CAREFIRST OF MD | OTHER |