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Individual provider Active NPI

Elizabeth Layne Shadis, CRNP

  • Gerontology Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1275545980
Registry record updated Aug 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
R122580 Issued in MD
Practice address
1331 S Hanover St
Baltimore, MD 21230-4220
Phone
(443) 996-7528
Fax
(410) 837-1552
NPI assigned
Aug 12, 2006
Last updated
Aug 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X R122580 MD Primary

Addresses

Primary practice location

1331 S Hanover St
Baltimore, MD 21230-4220

Mailing address

6334 Cedar LN Ste 103
Columbia, MD 21044-4172
Phone (410) 531-2355

Other names 1

  • Elizabeth Layne Conelius Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081023000099 MD Practitioner - Nurse Practitioner 5496813271 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Maryland School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogeecare Medical Group of Maryland, P.C.Group PAC ID 8921505488, 2 clinicians
Personal Physician Care, LLCGroup PAC ID 3274683289, 13 clinicians

Practice addresses (Care Compare)

1910 Towne Centre Blvd
Suite 250
Annapolis, MD 21401-3599
Phone (410) 200-9988

6334 Cedar LN
Suite 103
Columbia, MD 21044-4172
Phone (410) 531-2355

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R122580MDMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Five Star Physician Services, LLC CurrentSince Jan 1, 2013 Accepting new patients
Apogeecare Medical Group of Maryland, P.C. CurrentSince Jan 11, 2026 Accepting new patients
Personal Physician Care, LLC CurrentSince May 1, 2013 Accepting new patients

Locations

1910 Towne Centre Blvd
Ste 250
Annapolis, MD 21401
Phone (202) 596-8891

8700 Jones Mill Rd
Chevy Chase, MD 20815
Phone (301) 350-5555

6334 Cedar Ln
Ste 103
Columbia, MD 21044
Phone (410) 531-2355

785 Elkridge Landing Rd
Ste 300
Linthicum Heights, MD 21090
Phone (443) 323-3014

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724544000000",
    "number": "1275545980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6334 CEDAR LN STE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210444172",
            "telephone_number": "410-531-2355",
            "fax_number": "410-531-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 S HANOVER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212304220",
            "telephone_number": "443-996-7528",
            "fax_number": "410-837-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADIS",
        "first_name": "ELIZABETH",
        "middle_name": "LAYNE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2024-08-25",
        "certification_date": "2024-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R122580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "CONELIUS",
            "middle_name": "LAYNE",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.