Individual provider Active NPI

Karen Gayle Ganacias, M.D.

  • Pediatrics Physician
  • Severna Park, MD
National Provider Identifier
1174834865
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D86067 Issued in MD
Practice address
692A Ritchie Hwy
Severna Park, MD 21146-3971
Phone
(410) 721-2273
NPI assigned
Jun 28, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D86067 MD Primary

Addresses

Primary practice location

692A Ritchie Hwy
Severna Park, MD 21146-3971

Mailing address

1600 Granby St Apt 456
Norfolk, VA 23510-2661
Phone (913) 683-5707

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidMD

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200922000696 DC Practitioner - Pediatric Medicine 6901224039 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D86067MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince May 1, 2025 Accepting new patients
MGMC, LLC Current Accepting new patients
Medstar Medical Group II LLC CurrentSince May 1, 2025 Accepting new patients
Medstar Medical Group II LLC CurrentSince Sep 3, 2020 Accepting new patients
MGMC LLC CurrentSince Sep 3, 2020 Accepting new patients
The Pediatric Group LLP Pediatrics PastSince Feb 2, 2025 Accepting new patients
The Pediatric Group, LLP Pediatrics Past Accepting new patients
Guh Kids Mobile Medical Clinic Program, LLC Pediatrics Past Accepting new patients

Locations

4200 Wisconsin Ave NW
Washington, DC 20016
Phone (202) 243-3400

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

4200 Wisconsin Ave NW
Ste 4
Washington, DC 20016
Phone (202) 243-3400

4200 Wisconsin Ave NW
Ste 200
Washington, DC 20016
Phone (267) 825-2184

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

25500 Point Lookout Rd
Leonardtown, MD 20650
Phone (301) 475-6106

Organizations & group practices 8

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": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1174834865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 GRANBY ST APT 456",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102661",
            "telephone_number": "913-683-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692A RITCHIE HWY",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463971",
            "telephone_number": "410-721-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANACIAS",
        "first_name": "KAREN",
        "middle_name": "GAYLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-28",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D86067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Severna Park, MD

Sources for this page

Verify at the official NPI Registry.