Kimberly Destefano Larsen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D51722 Issued in MD

Practice address

4225 Altamont PL Ste 201
White Plains, MD 20695-3065

Phone

(240) 607-1500

NPI assigned

May 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: kimberly.larsenmd.p2@direct.msmg.nextgenshare.com

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 Physician Services, LLLP

  • General Acute Care Hospital
  • Westminster, MD
  • NPI 1457302713
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1265480347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9910 FRANKLIN SQUARE DR STE 2110",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212364902",
            "telephone_number": "410-933-5412",
            "fax_number": "410-535-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 ALTAMONT PL STE 201",
            "city": "WHITE PLAINS",
            "state": "MD",
            "postal_code": "206953065",
            "telephone_number": "240-607-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Hospital Dr",
            "address_2": "Suite 111",
            "address_purpose": "LOCATION",
            "city": "Prince Frederick",
            "state": "MD",
            "postal_code": "20678",
            "country_code": "US",
            "telephone_number": "410-535-4488",
            "fax_number": "410-535-6131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "KIMBERLY",
        "middle_name": "DESTEFANO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D51722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEDERAL",
            "identifier": "5619003",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123200560",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Merriman Kost, RN
• Edith Kratzer, RN
• Kssential Nutrition LLC
• Adenike Kupolati, RPH
• Meghan A Lainoff, PA-C
• Shelby Lawanson
• Eileen Leahy, NP
• Soo Yun Stacy Lee, D.D.S.
• Shanice Renee Levy
• Ti'Aesha K Lewis

• Family Medicine Physician in White Plains, MD
• Providers in White Plains, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.