Organization Active NPI

Luminis Health Medical Group, LLC

Doing business as Anne Arundel Medical Group - Kent Island Primary Care

  • Internal Medicine Physician
  • Chester, MD
National Provider Identifier
1134540693
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LUMINIS HEALTH MEDICAL GROUP, LLC
Doing business as
Anne Arundel Medical Group - Kent Island Primary Care
Practice address
1630 Main St Ste 101
Chester, MD 21619-2792
Phone
(410) 604-6560
NPI assigned
Dec 30, 2013
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Melissa Rapattoni
Title
Ao
Phone
(443) 481-5136

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1630 Main St Ste 101
Chester, MD 21619-2792

Mailing address

2000 Medical Pkwy Ste 409
Annapolis, MD 21401-3746

Other names 1

  • Anne Arundel Medical Group - Kent Island Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

1630 Main St
Ste 204
Chester, MD 21619
Phone (410) 224-4887

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1388361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1134540693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MEDICAL PKWY STE 409",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 MAIN ST STE 101",
            "city": "CHESTER",
            "state": "MD",
            "postal_code": "216192792",
            "telephone_number": "410-604-6560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINIS HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-30",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anne Arundel Medical Group - Kent Island Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Anne Arundel Medical Group - Kent Island Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chester, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.