Individual provider Active NPI

Kathleen Cullum

  • Family Nurse Practitioner
  • Hunt Valley, MD
National Provider Identifier
1295106722
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R194317 Issued in MD
Practice address
11121 York Rd
Hunt Valley, MD 21030-2006
Phone
(410) 628-2026
NPI assigned
Oct 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R194317 MD Primary

Addresses

Primary practice location

11121 York Rd
Hunt Valley, MD 21030-2006

Mailing address

3718 Norrisville Road
Suite C
Jarrettsville, MD 21084

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151215002361 MD Practitioner - Nurse Practitioner 4284935321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
George Washington University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians
Maryland Family Care IncGroup PAC ID 5092629394, 157 clinicians

Practice addresses (Care Compare)

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

7602 Belair Rd
Baltimore, MD 21236-4088
Phone (410) 663-8100

Hospital & facility affiliations

  • Home Call, Inc Home health agency, Westminster, MD, CCN 217115

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R194317MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Family Care, Inc. CurrentSince Nov 18, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

11121 York Rd
Hunt Valley, MD 21030
Phone (410) 628-0026

7602 Belair Rd
Nottingham, MD 21236
Phone (410) 332-9654

Interoperability endpoints

  • Direct secure messaging: kcullum34225@direct.mdmercy.com

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": "1444348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1295106722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3718 NORRISVILLE ROAD",
            "address_2": "SUITE C",
            "city": "JARRETTSVILLE",
            "state": "MD",
            "postal_code": "21084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11121 YORK RD",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210302006",
            "telephone_number": "410-628-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLUM",
        "first_name": "KATHLEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-09",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R194317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hunt Valley, MD

Sources for this page

Verify at the official NPI Registry.