Individual provider Active NPI

Kendra Lucinda Homer, RN

  • School Registered Nurse
  • Baltimore, MD
National Provider Identifier
1235709668
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
R247683 Issued in MD
Practice address
525 N Wolfe St
Baltimore, MD 21205-2110
Phone
(410) 955-4766
NPI assigned
Jun 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X R247683 MD Primary

Addresses

Primary practice location

525 N Wolfe St
Baltimore, MD 21205-2110

Mailing address

618 S Port St
Baltimore, MD 21224-3647
Phone (760) 713-7126

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240813000788 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012455785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rector and Visitors of the University of VirginiaGroup PAC ID 4789592718, 96 clinicians

Practice addresses (Care Compare)

1215 Lee St
Charlottesville, VA 22908-0816
Phone (434) 924-0000

Hospital & facility affiliations

  • University of Virginia Medical Center Hospital, Charlottesville, VA, CCN 490009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R247683MDMDSchool Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Rector and Visitors of the University of Virginia CurrentSince Aug 5, 2024 Accepting new patients
Rector & Visitors of the University of Virginia CurrentSince Aug 5, 2024 Accepting new patients
Rector & Visitors of the University of Virginia Current Accepting new patients

Locations

2955 Ivy Rd
Ste 201
Charlottesvle, VA 22903
Phone (434) 243-4520

1215 Lee St
Charlottesvle, VA 22908
Phone (434) 924-0211

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1235709668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 S PORT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243647",
            "telephone_number": "760-713-7126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N WOLFE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212052110",
            "telephone_number": "410-955-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMER",
        "first_name": "KENDRA",
        "middle_name": "LUCINDA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "MD",
            "license": "R247683",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.