579TH MEDICAL GROUP (NPI# 1013988328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013988328 |
| Entity Type | Organization |
| Organization Name | 579TH MEDICAL GROUP |
| Practice Address |
238 Brookley Ave Washington DC 20032 |
| Mailing Address |
1050 W Perimeter Rd Fb14 Andrews Afb MD 20762-6600 |
| Practice Telephone | 2024043602 |
| Practice Fax Number | 2024048233 |
| Mailing Telephone | 2024043602 |
| Mailing Fax Number | 2024048233 |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2014-02-24 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UNIFORM BUSINESS OFFICE) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | Y |
| Parent Organization Name | MALCOLM GROW MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1103X |
Clinic/Center Specialization: Military Ambulatory Procedure Visits Operational (Transportable) |
Ambulatory Health Care Facilities | ||
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DC | NCPDP | 09-04208 | 01 |
| Street Address |
238 BROOKLEY AVE |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548575525 | Sarrah A Armstrong | Dentist | 238 Brookley Ave, Bldg 1300, Washington, DC 20032 | 2010-08-13 |
| 1083814289 | Sonja L. Cooke | Nutritionist | 238 Brookley Ave, Joint Base Anacostia Bolling, Washington, DC 20032 | 2007-07-25 |
| 1497727515 | Erik John Meyers | Dentist | 238 Brookley Ave, Bolling Afb, Washington, DC 20332-0001 | 2006-02-02 |
| 1285623447 | Linda Trew Bruhn | Psychologist | 238 Brookley Ave, 1300, Washington, DC 20032 | 2005-10-19 |
| 1740282656 | William Granger Spangle | Dentist | 238 Brookley Ave, Washington, DC 20338-0001 | 2005-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336753714 | Ebonie Hawkins | Counselor | 101 Xenia St Suite 200 Sw, Washington, DC 20032 | 2020-09-03 |
| 1639788938 | Richard Quinones | Technician | 4346 Livingston Rd Se, B, Washington, DC 20032 | 2020-07-23 |
| 1720603244 | Ankur Sah Swarnakar | Student in an Organized Health Care Education/Training Program | 1100 Alabama Ave Southeast, 2nd Floor, Suite 238, Washington, DC 20032 | 2020-06-10 |
| 1225659519 | Michael Thomas Moore | Counselor | 920 Belview St. Se, Washington, DC 20032 | 2020-04-28 |
| 1144878240 | Erika Kirkpatrick | Behavior Technician | 1218 Southern Ave Apt304 Se, Washgton Dc, DC 20032 | 2019-08-31 |
| 1982251351 | Agazit Asihel | Counselor | Friendship Charter School 645 Milwaukee Pl, Washington Dc, DC 20032 | 2019-08-21 |
| 1538715412 | Omonike Grace Adeosun | Home Health Aide | 2625 Martin Luther King Jr Ave Se, Apt 1, Washington, DC 20032 | 2019-08-15 |
| 1932753571 | Nadesh Mengwi Muluh | Home Health Aide | 2759 Martin Luther King Jr Avenue, Washington, DC 20032 | 2019-08-01 |
| 1376100115 | Kelsey Hobart | Student in an Organized Health Care Education/Training Program | Dc Dbh Seh Psych Residency 1100 Alabama Avenue, Se, Suite 238, Washington, DC 20032 | 2019-05-28 |
| 1407321417 | Abigail Christine Burke | Physical Therapist | 3146 Arnold Avenue Sw, Washington, DC 20032 | 2018-10-05 |
| Find all providers in zip 20032 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265639918 | Branch Medical Clinic Washington Navy Yard | Clinic/Center | 915 N Street Southeast, Suite 210, Washington, DC 20374-5162 | 2007-06-27 |
| 1881897544 | National Naval Medical Center | Clinic/Center | The Pentagon, Corridor 8, Washington, DC 20310-0001 | 2007-06-08 |
| 1467538371 | Uscg Headquarters Support Command (k) | Clinic/Center | Comdt 2100 2nd St Sw, Cg-1122, Suite 5314, Washington, DC 20593-0001 | 2006-10-31 |
| 1033312798 | Wramc | Clinic/Center | 6900 Georgia Ave, Usadc, Washington, DC 20310-0001 | 2007-06-08 |
| 1205042926 | Wramc | Clinic/Center | Pentagon, Washington, DC 20310-0001 | 2007-05-16 |
| 1285759712 | Uscg Ralph Nix Medical | Clinic/Center | Uscg Hq Comdt (cg-1122), 2100 Second Street South West, Washington, DC 20593-0001 | 2007-03-21 |
| 1740325380 | Uscg Air Station Barbers Point Clinic | Clinic/Center | Comdt Cg-1122, Washington, DC 20593-0001 | 2007-02-21 |
| 1326191073 | U.s Coast Guard | Clinic/Center | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2007-01-18 |
| 1003968942 | Uscg Isc San Pedro Clinic | Clinic/Center | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2007-01-18 |
| 1477538361 | Uscg Air Station Port Angeles Medcial/dental Clinic | Clinic/Center | Commandant Uscg Hq (cg-1122), 2100 2nd Street, Washington, DC 20593-0001 | 2005-12-13 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20032 |
Please comment or provide details below to improve the information on 579TH MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.