OrganizationActive
Phs Internal Medicine Dp311
NPI 1124496013 · Internal Medicine Physician · Washington, DC
Provider details
- NPI number
- 1124496013
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Providence Hospital
- Organization subpart
- Yes
- Authorized official
- Beau Higginbotham, Vice President/Coo(410) 368-3162
- License
- HFD01-0212 (DC)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(73/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1160 Varnum St Ne
Depaul 311
Washington, DC 20017-2107
Phone: (202) 854-4470
Fax: (202) 854-4471
Street-level locationGet directions
Mailing address
1160 Varnum St Ne
Washington, DC 20017-2107
Other names (DBA / former)
- Doing business as
- Providence Health Services
Registry dates
- Enumerated
- 2015-09-09
- Last updated
- 2017-10-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.