Awesome Experience Psychiatric Services Llc is a medicare enrolled primary clinic (Clinic/center - Multi-specialty) in Saint Charles, Maryland. The current practice location for Awesome Experience Psychiatric Services Llc is 12070 Old Line Ctr Ste 211, Saint Charles, Maryland. For appointments, you can reach them via phone at
(202) 600-6748. The mailing address for Awesome Experience Psychiatric Services Llc is 12070 Old Line Ctr Ste 211, Saint Charles, Maryland and phone number is (202) 600-6748.
Awesome Experience Psychiatric Services Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1457949018. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(202) 600-6748.
Primary Care Clinic Profile
| Full Name | Awesome Experience Psychiatric Services Llc |
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| Speciality | Clinic/Center |
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| Location | 12070 Old Line Ctr Ste 211, Saint Charles, Maryland |
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| Authorized Official Name and Position | Siyami Takha (PROVIDER) |
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| Authorized Official Contact | 2027054133 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Awesome Experience Psychiatric Services Llc
12070 Old Line Ctr Ste 211
Saint Charles
MD 20602-2567
Ph: (202) 600-6748 | Awesome Experience Psychiatric Services Llc
12070 Old Line Ctr Ste 211
Saint Charles
MD 20602-2567
Ph: (202) 600-6748 |
NPI Details:
| NPI Number | 1457949018 |
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| Provider Enumeration Date | 01/08/2021 |
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| Last Update Date | 02/09/2026 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 0143635342 |
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| Medicare Enrollment ID | O20210729003628 |
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Medical Identifiers
Medical identifiers for Awesome Experience Psychiatric Services Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1457949018 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Awesome Experience Psychiatric Services Llc acts as a billing entity for following providers:
| Provider Name | Siyami Takha |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1760995021
PECOS PAC ID: 7911335658
Enrollment ID: I20200313000005 |
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