NPIMap

Organization Active NPI

Kennedy Krieger Associates, Inc - Mental Health Group Provider

  • Pediatrics Physician
  • Baltimore, MD
National Provider Identifier
1215327259
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KENNEDY KRIEGER ASSOCIATES, INC - MENTAL HEALTH GROUP PROVIDER
Practice address
707 N. Broadway
Baltimore, MD 21205
Phone
(443) 923-9200
Fax
(443) 923-9405
NPI assigned
Jan 29, 2015
Organization subpart
Yes
Parent organization
KENNEDY KRIEGER INSTITUTEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Mr. Mike J Neuman
Title
Vice President Finance
Phone
(443) 923-1810

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

707 N. Broadway
Baltimore, MD 21205

Mailing address

P.O. Box 744865
Atlanta, GA 30374
Phone (443) 923-1872

Other identifiers 3

IdentifierTypeStateIssuer
168641100MedicaidMD
F158OtherMDBLUE CROSS FEDERAL
K631OtherMDBLUE CROSS MARYLAND

National Provider Directory

National Provider Directory
Tax ID family
Kennedy Krieger Associates15 organizations share this tax ID, including this one
Part of
Kennedy Krieger Childrens Hospital Inc

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1215327259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 744865",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30374",
            "telephone_number": "443-923-1872",
            "fax_number": "443-923-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N. BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21205",
            "telephone_number": "443-923-9200",
            "fax_number": "443-923-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY KRIEGER ASSOCIATES, INC - MENTAL HEALTH GROUP PROVIDER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY KRIEGER INSTITUTE",
        "enumeration_date": "2015-01-29",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "443-923-1810",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168641100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FEDERAL",
            "identifier": "F158",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MARYLAND",
            "identifier": "K631",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.