Individual provider Active NPI

Cheryl L Krissoff, M.S.-CCC-A

  • Audiologist
  • Columbia, MD
National Provider Identifier
1295749836
Registry record updated Jul 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
00566 Issued in MD
Practice address
8818 Centre Park Drive
Suite 107
Columbia, MD 21045
Phone
(410) 740-4885
Fax
(410) 740-4677
NPI assigned
Jul 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 00566 MD Primary

Addresses

Primary practice location

8818 Centre Park Drive
Suite 107
Columbia, MD 21045

Mailing address

8818 Centre Park Drive
Suite 107
Columbia, MD 21045
Phone (410) 740-4885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040105000837 MD Practitioner - Qualified Audiologist 9830098243
I20040121000215 DC Practitioner - Qualified Audiologist 9830098243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1988
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11400 N Jog Rd
Palm Beach Gardens, FL 33418-1756

P O Box
Suite 200132
Dallas, TX 75320

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
00566MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Distribution, LLC CurrentSince Nov 27, 2024 Accepting new patients
Hearx West, LLC Past Accepting new patients

Locations

11400 N Jog Rd
Palm Beach Gardens, FL 33418
Phone 5614788770 ext. 181

8818 Centre Park Dr
Ste 107
Columbia, MD 21045
Phone (410) 740-4885

3402 Olandwood Ct
Olney, MD 20832
Phone (301) 260-0966

500 Market St
Ste 110
Pocomoke City, MD 21851
Phone (410) 957-2535

6647B Old Dominion Dr
Mc Lean, VA 22101
Phone (703) 663-1057

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280188800000",
    "number": "1295749836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8818 CENTRE PARK DRIVE",
            "address_2": "SUITE 107",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "21045",
            "telephone_number": "410-740-4885",
            "fax_number": "410-740-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8818 CENTRE PARK DRIVE",
            "address_2": "SUITE 107",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "21045",
            "telephone_number": "410-740-4885",
            "fax_number": "410-740-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISSOFF",
        "first_name": "CHERYL",
        "middle_name": "L",
        "credential": "M.S.-CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2010-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MD",
            "license": "00566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; 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.