NPIMap

Individual provider Active NPI

Karly Peterson, PA-C

  • Physician Assistant
  • Salisbury, MD
National Provider Identifier
1316329378
Registry record updated May 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0005714 Issued in MD
Practice address
505 E Main St
Salisbury, MD 21804-5020
Phone
(410) 341-3420
Fax
(410) 341-3397
NPI assigned
Jun 25, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X C0005714 MD
Physician Assistant 363A00000X C0005714 MD Primary

Addresses

Primary practice location

505 E Main St
Salisbury, MD 21804-5020

Mailing address

505 E Main St
Salisbury, MD 21804-5020
Phone (410) 341-3420

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
I20180724001866 MD Practitioner - Physician Assistant 2860749769 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

1630 Main St
Chester, MD 21619-2793

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Aug 15, 2022 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Aug 15, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

1630 Main St
Chester, MD 21619
Phone (410) 604-2555

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

Interoperability endpoints

  • Direct secure messaging: kpeterson142434@direct.aahs.org

Organizations & group practices 4

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 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": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558396800000",
    "number": "1316329378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E MAIN ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218045020",
            "telephone_number": "410-341-3420",
            "fax_number": "410-341-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E MAIN ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218045020",
            "telephone_number": "410-341-3420",
            "fax_number": "410-341-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KARLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-25",
        "last_updated": "2019-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0005714",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.