Kelsey Brianna Suppa, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

301 Hospital Dr
Glen Burnie, MD 21061

Phone

(410) 787-4000

NPI assigned

Jan 16, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kelsey Brianna Suppa Former name

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13394/brand/1/csg/1/fhir/r4
• Direct secure messaging: ksuppa1028381@direct.umm.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wisecare, LLC

  dba WiseCare Express Urgent Care Center

  • Urgent Care Clinic/Center
  • Pasadena, MD
  • NPI 1053728634
  Medicare reassignment NPD
• Privia Care Center LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1164874426

  MD

  Medicare reassignment NPD
• Baltimore Washington Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Glen Burnie, MD
  • NPI 1215983853
  Medicare reassignment
• Menocal Medical Services PA

  • Family Medicine Physician
  • Frederick, MD
  • NPI 1083795918
  NPD
• Medical Associates of Central Virginia, Inc.

  • Internal Medicine Physician
  • Lynchburg, VA
  • NPI 1912970260
  NPD (past)

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

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1053700815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 OAK RD",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463402",
            "telephone_number": "410-491-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "21061",
            "telephone_number": "410-787-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4940 Eastern Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212242735",
            "country_code": "US",
            "telephone_number": "410-491-2212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPPA",
        "first_name": "KELSEY",
        "middle_name": "BRIANNA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-16",
        "last_updated": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "MD",
            "license": "C0005671",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "SUPPA",
            "middle_name": "BRIANNA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Sunstone (Balance & Birch)
• Surgcenter of Glen Burnie (SurgCenter of Glen Burnie, LLC)
• Surgical Assist Services LLC
• Juan A Suriel, MD
• Sushma Bhasin
• Sushma Bhasin (Sushma Bhasin MD)

• Physician Assistant in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.