NPIMap

Individual provider Active NPI

Kimberly Sue Maynard, CRNP-F

  • Family Nurse Practitioner
  • Westernport, MD
National Provider Identifier
1063661635
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R144591 Issued in MD
Practice address
22221 Westernport Rd SW
Westernport, MD 21562
Phone
(240) 774-0204
Fax
(301) 533-3299
NPI assigned
Sep 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R144591 MD Primary

Addresses

Primary practice location

22221 Westernport Rd SW
Westernport, MD 21562

Mailing address

22221 Westernport Rd SW
McCoole, MD 21562-2206
Phone (301) 533-3300

Other practice location 1

104 Parkview Dr
Grantsville, MD 21536-1086
Phone (844) 652-8730

Other practice location 2

1027 Memorial Dr
Oakland, MD 21550-4343
Phone (301) 533-3300 ext. 3081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150327000855 MD Practitioner - Nurse Practitioner 8527234533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Maryland Health Care CorporationGroup PAC ID 9436152493, 29 clinicians

Practice addresses (Care Compare)

1027 Memorial Dr
Oakland, MD 21550-4343
Phone 30153333003081

22221 Westernport Rd SW
Westernport, MD 21562-2206
Phone (240) 774-0204

Hospital & facility affiliations

  • Upmc Western Maryland Home health agency, Cumberland, MD, CCN 217031
  • Potomac Valley Hospital Hospital, Keyser, WV, CCN 511315
  • Western Maryland Regional Medical Center Hospital, Cumberland, MD, CCN 210027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Western Maryland Health Care Corporation CurrentSince Jun 3, 2019 Accepting new patients
Western Maryland Health Care Corporation Current Accepting new patients
Western Maryland Health Care Corporation CurrentSince Jun 3, 2019 Accepting new patients
Western Maryland Health Care Corporation Past Accepting new patients
Western Maryland Health Care Corporation Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

28 Hershberger Ln
Grantsville, MD 21536
Phone (301) 895-5107

104 Parkview Dr
Grantsville, MD 21536
Phone (301) 895-5107

1027 Memorial Dr
Oakland, MD 21550
Phone (301) 533-3300

22221 Westernport Rd SW
Westernport, MD 21562
Phone (240) 774-0204

Interoperability endpoints

  • Direct secure messaging: kimberly.maynard.1@28818.direct.athenahealth.com

Organizations & group practices 7

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1063661635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22221 WESTERNPORT RD SW",
            "city": "MCCOOLE",
            "state": "MD",
            "postal_code": "215622206",
            "telephone_number": "301-533-3300",
            "fax_number": "301-533-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22221 WESTERNPORT RD SW",
            "city": "WESTERNPORT",
            "state": "MD",
            "postal_code": "21562",
            "telephone_number": "240-774-0204",
            "fax_number": "301-533-3299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Parkview Dr",
            "address_purpose": "LOCATION",
            "city": "Grantsville",
            "state": "MD",
            "postal_code": "215361086",
            "country_code": "US",
            "telephone_number": "844-652-8730",
            "fax_number": "301-533-3299",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1027 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "MD",
            "postal_code": "215504343",
            "country_code": "US",
            "telephone_number": "301-533-3300 x3081",
            "fax_number": "301-533-3299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "CRNP-F",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R144591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westernport, MD

Sources for this page

Verify at the official NPI Registry.