NPIMap

Organization Active NPI

Graceway Health Care LLC

  • Internal Medicine Physician
  • Bel Air, MD
National Provider Identifier
1104648179
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRACEWAY HEALTH CARE LLC
Practice address
410 E Macphail Rd
Bel Air, MD 21014-4410
Phone
(667) 300-8222
NPI assigned
Oct 30, 2024
Last updated
Feb 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Authorized official

Name
Krystle D Brown
Title
Practice Administrator
Phone
(410) 800-6251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

410 E Macphail Rd
Bel Air, MD 21014-4410

Mailing address

10259 Cabery Rd
Ellicott City, MD 21042-1605
Phone (410) 870-9380

Other names 1

  • Graceway Health Care, LLC - Bel AIr Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220909001488 MD Part B Supplier - Clinic/Group Practice 9537544648 Receives reassigned benefits from 16 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elkton, MD; Ellicott City, MD; Timonium, MD; Towson, MD; Bel Air, MD; Catonsville, MD; Annapolis, MD; Baltimore, MD

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Graceway Health Care LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1104648179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10259 CABERY RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210421605",
            "telephone_number": "410-870-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E MACPHAIL RD",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144410",
            "telephone_number": "667-300-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEWAY HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "410-800-6251"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceway Health Care, LLC - Bel AIr",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Graceway Health Care, LLC - Bel AIr",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.