Individual provider Active NPI

Kristen Davis, PA-C

  • Physician Assistant
  • Annapolis, MD
National Provider Identifier
1093719676
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C02999 Issued in MD
Practice address
2000 Medical Pkwy
Ste 101
Annapolis, MD 21401-3742
Phone
(410) 268-8862
Fax
(410) 280-4701
NPI assigned
Jun 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C02999 MD Primary

Addresses

Primary practice location

2000 Medical Pkwy
Ste 101
Annapolis, MD 21401-3742

Mailing address

2000 Medical Pkwy
Ste 101
Annapolis, MD 21401-3742
Phone (410) 268-8862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050202001002 MD Practitioner - Physician Assistant 4486605888 Reassigns benefits to 1 organization
I20050218000075 DC Practitioner - Physician Assistant 4486605888

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Johns Hopkins UniversityGroup PAC ID 8921903147, 2,886 clinicians

Practice addresses (Care Compare)

10700 Charter Dr
Columbia, MD 21044-3629
Phone (443) 546-1575

4940 Eastern Ave
Baltimore, MD 21224-2735
Phone (410) 550-0100

6201 Greenleigh Ave
Middle River, MD 21220-2004

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C02999MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Dec 9, 2018 Accepting new patients
Johns Hopkins University CurrentSince Dec 9, 2018 Accepting new patients
Orthopaedic and Sports Medicine Center LLC Past Accepting new patients
Medstar Harbor Hospital Physicians LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Harbor Hospital Past Accepting new patients
Orthopaedic and Sports Medicine Center LLC Past Accepting new patients
Luminis Health Medical Group, LLC Past Accepting new patients

Locations

4940 Eastern Ave
Baltimore, MD 21224

600 N Wolfe St
Baltimore, MD 21287

Interoperability endpoints

  • Direct secure messaging: kdavis7237@direct.hopkinsmedicine.org

Organizations & group practices 9

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 3

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": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1093719676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MEDICAL PKWY",
            "address_2": "STE 101",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013742",
            "telephone_number": "410-268-8862",
            "fax_number": "410-280-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 MEDICAL PKWY",
            "address_2": "STE 101",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013742",
            "telephone_number": "410-268-8862",
            "fax_number": "410-280-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KRISTEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-10",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C02999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.