OrganizationActive

Prevention &management Outreach Clinic Inc.

NPI 1619122504 · Preferred Provider Organization · Columbia, MD

Provider details

NPI number: 1619122504
Entity type: Organization
Primary specialty: Preferred Provider OrganizationManaged Care Organizations
Parent organization: 438-31-0969
Organization subpart: Yes
Authorized official: Lisa Bush, President/Ceo(410) 312-3126

Specialties & taxonomies

Preferred Provider OrganizationPrimary305R00000X
Managed Care Organizations
Preferred Provider Organization305R00000X
Managed Care Organizations
Preferred Provider Organization305R00000XLicense 0000000000 (MD)
Managed Care Organizations
Preferred Provider Organization305R00000XLicense 30500000X (MD)
Managed Care Organizations

Profile Score

Detailed profile(86/100 index)

A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.

Registry tenure38% of score
17 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

5941 Millrace Ct Unit D103

Columbia, MD 21045-7204

Phone: (410) 312-3126

Street-level locationGet directions

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Mailing address