Keon M Vasudevan, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D79802 Issued in MD

Practice address

7450 Albert Rd
1St Floor
Brandywine, MD 20613-3035

Phone

(301) 888-2233

NPI assigned

May 30, 2012

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 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keon.vasudevan@gbms.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Brandywine, MD
  • NPI 1912927344

  DC, Pediatrics

  Medicare reassignment NPD
• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Lexington Park, MD
  • NPI 1487469243
  NPD
• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Oxon Hill, MD
  • NPI 1083950521
  NPD (past)
• Greater Baden Medical Service Incorporated

  • Dental Clinic/Center
  • Brandywine, MD
  • NPI 1720297278
  NPD (past)

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1265793897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 ALBERT RD FL 3",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133035",
            "telephone_number": "301-888-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 ALBERT RD",
            "address_2": "1ST FLOOR",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133035",
            "telephone_number": "301-888-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASUDEVAN",
        "first_name": "KEON",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-30",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D79802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "550018400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• University of Maryland Surgical Associates, PA (Office Um Vascular Ctr at Brandywine-Surgical Oncology)
• University of Maryland Surgical Associates, PA (Office Um Vascular Center at Brandywine-Plastic Surgery)
• University of Maryland Surgical Associates, PA (Office Um Vascular Ctr at Brandywine-Urology)
• University of Maryland Surgical Associates, PA (Office Um Vascular Ctr at Brandywine-Peds Surgery)
• Vascular Access Center of Southern Maryland LLC
• Visionworks, Inc (Visionworks)
• Visionworks, Inc. (Visionworks)
• Vital Point Mobile Lab
• Kimberli Walker, DPT
• Tracey Lynn Wallace, AU.D., CCC/A

• Pediatrics Physician in Brandywine, MD
• Providers in Brandywine, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; 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.