Individual provider Active NPI

Stephanie Detterline, MD

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1104890367
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D67439 Issued in MD
Practice address
201 E University Pkwy
33Rd St. Professional BLDG, Ste 405
Baltimore, MD 21218-2829
Phone
(410) 554-2284
Fax
(410) 554-2184
NPI assigned
Feb 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36113740 IL
Hospitalist Physician 208M00000X 036113740 IL
Internal Medicine Physician 207R00000X 35089436 OH
Hospitalist Physician 208M00000X 35089436 OH
Internal Medicine Physician 207R00000X D67439 MD Primary

Addresses

Primary practice location

201 E University Pkwy
33Rd St. Professional BLDG, Ste 405
Baltimore, MD 21218-2829

Mailing address

201 E University Pkwy
33Rd St. Professional BLDG, Ste 405
Baltimore, MD 21218-2829
Phone (410) 554-2284

Other identifiers 4

IdentifierTypeStateIssuer
7100007510MedicaidKY
2745748MedicaidOH
36113740MedicaidIL
200867020MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080822000123 MD Practitioner - Internal Medicine 6103855705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

201 E University Pkwy
Baltimore, MD 21218-2829
Phone (410) 554-2000

Hospital & facility affiliations

  • Medstar Franklin Square Medical Center Hospital, Rosedale, MD, CCN 210015

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 Medicine

State licenses

LicenseStateTypeSpecialty
36113740ILMDInternal Medicine Physician
D67439MDMDInternal Medicine Physician
036113740ILMDHospitalist Physician
35089436OHMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Jul 1, 2021 Accepting new patients
Union Memorial Hospital Past Accepting new patients
University Internal Medicine Associates, Inc. Internal Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5601 Loch Raven Blvd
Baltimore, MD 21239
Phone (443) 444-4714

201 E University Pkwy
Baltimore, MD 21218
Phone (410) 554-2651

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

9000 Franklin Square Dr
Rosedale, MD 21237
Phone (410) 682-7000

Organizations & group practices 4

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 1

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1104890367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E UNIVERSITY PKWY",
            "address_2": "33RD ST. PROFESSIONAL BLDG, STE 405",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212182829",
            "telephone_number": "410-554-2284",
            "fax_number": "410-554-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E UNIVERSITY PKWY",
            "address_2": "33RD ST. PROFESSIONAL BLDG, STE 405",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212182829",
            "telephone_number": "410-554-2284",
            "fax_number": "410-554-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTERLINE",
        "first_name": "STEPHANIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "36113740",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036113740",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35089436",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35089436",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D67439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100007510",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2745748",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36113740",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200867020",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.