NPIMap

Organization Active NPI

Graceway Health Care LLC

  • Internal Medicine Physician
  • Catonsville, MD
National Provider Identifier
1013669084
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRACEWAY HEALTH CARE LLC
Practice address
1222 Tugwell Dr
Catonsville, MD 21228-5847
Phone
(667) 300-8222
NPI assigned
Jan 21, 2022
Last updated
Nov 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Krystle Brown
Title
Practice Administrator
Phone
(410) 800-6251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1222 Tugwell Dr
Catonsville, MD 21228-5847

Mailing address

10259 Cabery Rd
Ellicott City, MD 21042-1605
Phone (410) 870-9380

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220909001488 MD Part B Supplier - Clinic/Group Practice 9537544648 Receives reassigned benefits from 16 practitioners
9 other NPIs on this enrollment
Practice locations: Elkton, MD; Ellicott City, MD; Timonium, MD; Towson, MD; Bel Air, MD; Catonsville, MD; Annapolis, MD; Baltimore, MD
O20221005002859 DC Part B Supplier - Clinic/Group Practice 9537544648 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

4700 Harford Rd
Baltimore, MD 21214
Phone (410) 254-3300

10175 Little Patuxent Pkwy
Columbia, MD 21044
Phone (800) 888-1965

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1013669084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10259 CABERY RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210421605",
            "telephone_number": "410-870-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 TUGWELL DR",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212285847",
            "telephone_number": "667-300-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEWAY HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-21",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "410-800-6251"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Catonsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.