Individual provider Active NPI

Kieran Johnston Maestro, PH.D.

  • Psychologist
  • Washington, DC
National Provider Identifier
1104565183
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY200001324 Issued in DC
Practice address
102 Irving St NW
Washington, DC 20010-2921
Phone
(518) 928-1326
NPI assigned
May 31, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 31, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 0810007802 VA
Psychologist 103T00000X PSY200001324 DC Primary

Addresses

Primary practice location

102 Irving St NW
Washington, DC 20010-2921

Mailing address

123 Harvard St
Alexandria, VA 22314-2712
Phone (518) 928-1326

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220927000042 DC Practitioner - Clinical Psychologist 4486030657 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

102 Irving St NW
Washington, DC 20010-3010
Phone (202) 877-1000

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810007802VAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Aug 16, 2022 Accepting new patients

Locations

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

102 Irving St NW
Washington, DC 20010
Phone (202) 877-1587

2000 15th St N
Ste 600
Arlington, VA 22201
Phone (202) 425-0000

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1104565183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 HARVARD ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223142712",
            "telephone_number": "518-928-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 IRVING ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102921",
            "telephone_number": "518-928-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAESTRO",
        "first_name": "KIERAN",
        "middle_name": "JOHNSTON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810007802",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "DC",
            "license": "PSY200001324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.