Individual provider Active NPI

Katie Rae Bennett, NP-C

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1215177464
Registry record updated Nov 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R158893 Issued in MD
Practice address
1000 E Eager St
Baltimore, MD 21202-5533
Phone
(410) 522-9800
Fax
(410) 522-5136
NPI assigned
Mar 1, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R158893 MD Primary

Addresses

Primary practice location

1000 E Eager St
Baltimore, MD 21202-5533

Mailing address

3100 Wyman Park Dr
Baltimore, MD 21211-2803
Phone (410) 338-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20180501002139 MA Practitioner - Nurse Practitioner 4789734062 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bostons Community Medical Group IncGroup PAC ID 1355390691, 31 clinicians

Practice addresses (Care Compare)

30 Northampton St
Boston, MA 02118-4098
Phone (617) 433-9601

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R158893MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boston'S Community Medical Group, Inc. CurrentSince Nov 1, 2025 Accepting new patients
Matrix Medical Plus CurrentSince Apr 1, 2022 Accepting new patients
Commonwealth Clinical Alliance, Inc CurrentSince Jan 1, 2026 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

3 Allied Dr
Dedham, MA 02026
Phone (404) 587-0945

30 Northampton St
Roxbury, MA 02118
Phone (617) 433-9601

3550 Main St
Ste 101
Springfield, MA 01107
Phone (413) 739-0669

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": "1235865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352851200000",
    "number": "1215177464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 WYMAN PARK DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212112803",
            "telephone_number": "410-338-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E EAGER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212025533",
            "telephone_number": "410-522-9800",
            "fax_number": "410-522-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "KATIE",
        "middle_name": "RAE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-01",
        "last_updated": "2012-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R158893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.