Active NPI
Grace Puthenpurackal, RD, LDN, CDE
- Registered Dietitian
- Salisbury, MD
National Provider Identifier
1316005580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DO1175
- Practice address
- 3993 Trace Hollow Run
Salisbury, MD 21804-2552 - Phone
- (410) 548-1860
- Fax
- (410) 341-4629
- NPI assigned
- Dec 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DO1175 | MD | Primary |
Addresses
Primary practice location
3993 Trace Hollow Run
Salisbury, MD 21804-2552
Mailing address
3993 Trace Hollow Run
Salisbury, MD 21804-2552
Phone (410) 548-1860
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6300008 | Other | MD | UNITED HEALTH CARE |
| 7758298 | Other | MD | CIGNA |
| S2360001 | Other | MD | BLUECHOICE,CAREFIRST |
| V00003940 | Other | MD | AMERICHOICEMA |
| 022022 | Other | MD | PRIORITYPARTNERS.JHHC |
| 0956915 | Other | MD | AETNA HMO |
| 328392 | Other | MD | PRIMEHEALTH |
| 228231300 | Medicaid | MD | |
| 7758298 | Other | MD | CIGNA,HMO,PPO |
| 238074 | Other | MD | AMERIHEALTH |
| 09DI | Other | MD | CAREFIRSTBCBS,PPO,POS |
| 216451 | Other | MD | ALLIANCE.MAMSI.MDIPA.OC |
| 216451 | Other | MD | AMERI HEALTH ADMINISTRATO |
| 5640256 | Other | MD | AETNA,PPO,POS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO1175 | MD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1316005580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3993 TRACE HOLLOW RUN",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218042552",
"telephone_number": "410-548-1860",
"fax_number": "410-341-4629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3993 TRACE HOLLOW RUN",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218042552",
"telephone_number": "410-548-1860",
"fax_number": "410-341-4629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTHENPURACKAL",
"first_name": "GRACE",
"credential": "RD, LDN, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MD",
"license": "DO1175",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "6300008",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "7758298",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECHOICE,CAREFIRST",
"identifier": "S2360001",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICEMA",
"identifier": "V00003940",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITYPARTNERS.JHHC",
"identifier": "022022",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "0956915",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIMEHEALTH",
"identifier": "328392",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "228231300",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA,HMO,PPO",
"identifier": "7758298",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH",
"identifier": "238074",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRSTBCBS,PPO,POS",
"identifier": "09DI",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIANCE.MAMSI.MDIPA.OC",
"identifier": "216451",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERI HEALTH ADMINISTRATO",
"identifier": "216451",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA,PPO,POS",
"identifier": "5640256",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.