Luminis Health Medical Group, LLC
Organization Active NPI Internal Medicine Physician · Annapolis, MD
NPI 1093342438 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1093342438
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- LUMINIS HEALTH MEDICAL GROUP, LLC
- Practice address
- 2003 Medical Pkwy Ste 350
Annapolis, MD 21401-3081 - Phone
- (443) 481-5618
- NPI assigned
- Mar 25, 2020
- Organization subpart
- No
Authorized official
- Name
- Melissa Rapattoni
- Title
- Ao
- Phone
- (443) 481-5136
Corporate family (same tax ID) 24
Practitioners 12
-
Ruchi Prasad, MD
-
Megan Stinefelt, DNP
-
Adam J Duhl, MD
-
Bryan Phillip Hendren, M.D.
-
Caitlin Moore, PA-C
-
Ashley Francesca Ayu, CRNP
-
Julie Ann Bache, CNM
-
Sarah Anne Brissey, CRNM
-
Danielle Destin Wilson, CNM, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2230265 | LH Advanced Internal Medical Clinic | Certificate of waiver | Jul 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050317000146 | MD | Part B Supplier - Clinic/Group Practice | 2860447315 |
Receives reassigned benefits from 897 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Anne Arundel Phys Group LLC
Locations
2000 Medical Pkwy
Ste 110
Annapolis, MD 21401
183 Harry S Truman Pkwy
Annapolis, MD 21401
183 Harry S Truman Pkwy
Ste 120
Annapolis, MD 21401
Phone (410) 266-9200
202 Coursevall Dr
Ste 105
Centreville, MD 21617
1630 Main St
Ste 112
Chester, MD 21619
Phone (443) 481-5300
9135 Piscataway Rd
Ste 210
Clinton, MD 20735
Phone (301) 645-4793
7501 Greenway Center Dr
#910
Greenbelt, MD 20770
Phone (301) 982-0657
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
2003 Medical Pkwy Ste 350
Annapolis, MD 21401-3081
Mailing address
2001 Medical Pkwy Ofc
Annapolis, MD 21401-3773
Phone (443) 481-5618
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | MD |
Other names
- Advanced Internal Medicine Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | hcecredenialling@aahs.org | ||
| Direct Messaging Address | hcecredentialing@aahs.org |
NPI Registry JSON
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1729036800000",
"number": "1093342438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 MEDICAL PKWY OFC",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214013773",
"telephone_number": "443-481-5618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2003 MEDICAL PKWY STE 350",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214013081",
"telephone_number": "443-481-5618"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LUMINIS HEALTH MEDICAL GROUP, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-03-25",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A",
"authorized_official_last_name": "RAPATTONI",
"authorized_official_first_name": "MELISSA",
"authorized_official_title_or_position": "AO",
"authorized_official_telephone_number": "443-481-5136"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "MD"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "hcecredenialling@aahs.org",
"affiliation": "N",
"address_1": "2003 Medical Pkwy Ste 350",
"city": "Annapolis",
"state": "MD",
"country_code": "US",
"postal_code": "214013081",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "hcecredentialing@aahs.org",
"affiliation": "N",
"address_1": "2001 Medical Pkwy Ofc",
"city": "Annapolis",
"state": "MD",
"country_code": "US",
"postal_code": "214013773",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Advanced Internal Medicine Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Advanced Internal Medicine Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Annapolis, MD
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC
All providers in Annapolis, MD · Internal 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 Oct 16, 2024. 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.
- 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.