Individual provider Active NPI

Mary F Haynos, CRNP

  • Adult Health Nurse Practitioner
  • Germantown, MD
National Provider Identifier
1154370377
Registry record updated Feb 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R113971 Issued in MD
Practice address
19701 Executive Park Cir
Germantown, MD 20874-2639
Phone
(301) 946-6623
Fax
(301) 946-1107
NPI assigned
May 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R113971 MD Primary

Addresses

Primary practice location

19701 Executive Park Cir
Germantown, MD 20874-2639

Mailing address

12001 Ferrara Ave
Silver Spring, MD 20906-4706
Phone (301) 279-2779

Other identifiers 1

IdentifierTypeStateIssuer
408582500MedicaidMD

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050928000680 DC Practitioner - Nurse Practitioner 9638104706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advanced Medical Care LLCGroup PAC ID 6204875396, 4 clinicians

Practice addresses (Care Compare)

12001 Ferrara Ave
Silver Spring, MD 20906-4706
Phone (301) 946-6623

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R113971MDMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Medical Care LLC Current Accepting new patients
Advanced Medical Care LLC CurrentSince Jan 8, 2018 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

19701 Executive Park Cir
Germantown, MD 20874
Phone (301) 540-9447

19703 Executive Park Cir
Germantown, MD 20874
Phone (301) 528-7029

12001 Ferrara Ave
Silver Spring, MD 20906
Phone (240) 660-2988

3925 Ferrara Dr
Silver Spring, MD 20906
Phone (301) 933-1547

Organizations & group practices 3

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": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517788800000",
    "number": "1154370377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12001 FERRARA AVE",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209064706",
            "telephone_number": "301-279-2779",
            "fax_number": "240-403-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19701 EXECUTIVE PARK CIR",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208742639",
            "telephone_number": "301-946-6623",
            "fax_number": "301-946-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNOS",
        "first_name": "MARY",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-06",
        "last_updated": "2018-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R113971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408582500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, MD

Sources for this page

Verify at the official NPI Registry.