Stephanie Lynn Davis, MD
Individual provider Active NPI Family Medicine Physician · Baltimore, MD
NPI 1013976091 · NPPES record last updated Feb 8, 2022
Key facts
- NPI
- 1013976091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- D0061643 (MD)
- Practice address
- 29 S Paca St
Lower Level
Baltimore, MD 21201-1771 - Phone
- (410) 328-8792
- Fax
- (410) 328-0716
- NPI assigned
- Mar 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 22
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Maryland School of Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaiser Foundation Health Plan of the Mid Atlantic States, Inc
Practice addresses (Care Compare)
3400 Box Hill Corporate Ctr Dr
Suite 100
Abingdon, MD 21009-1290
Phone (410) 515-5440
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040909001337 | MD | Practitioner - Family Practice |
2062488026 | Reassigns benefits to 1 organization |
| I20210630002997 | DC | Practitioner - Family Practice | 2062488026 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0061643 | MD | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Family Medicine | Current | Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Peoples Community Health Center, Inc | Past | Accepting new patients | |
| Peoples Community Health Center, Inc | Past | Accepting new patients |
Locations
3400 Box Hill Corporate Center Dr
Ste 100
Abingdon, MD 21009
Phone (310) 816-2424
7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600
2101 E Jefferson St
Ste 6
Rockville, MD 20852
2101 E Jefferson St
#4E
Rockville, MD 20852
2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853
1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | D0061643 | MD | Yes |
Addresses
Primary practice location
29 S Paca St
Lower Level
Baltimore, MD 21201-1771
Mailing address
3400 Box Hill Corporate Center Dr Ste 100
Abingdon, MD 21009-1290
Phone (800) 777-7904
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Other providers in Baltimore, MD
- Siminka Davis
- Sondra Davis
- Stephanie Ann Davis
- Stephanie Ersi Davis
- Stephanie Lyn Davis
- Stephen Neil Davis
- Susan Davis
- Taziah Davis
- Therese Christine Davis
- Thomas Davis
All providers in Baltimore, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.