Active NPI
Kyana Monique Idi, PA-C
- Physician Assistant
- Baltimore, MD
National Provider Identifier
1346575032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C0003961
- Practice address
- 2401 W Belvedere Ave
Baltimore, MD 21215-5216 - Phone
- (410) 601-5355
- NPI assigned
- Oct 14, 2009
- Last updated
- Apr 20, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C0003961 | MD | Primary |
Addresses
Primary practice location
2401 W Belvedere Ave
Baltimore, MD 21215-5216
Mailing address
2401 W Belvedere Ave
Baltimore, MD 21215-5216
Phone (410) 601-5355
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 |
|---|---|---|---|
| C0003961 | MD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461110400000",
"number": "1346575032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 W BELVEDERE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212155216",
"telephone_number": "410-601-5355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 W BELVEDERE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212155216",
"telephone_number": "410-601-5355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDI",
"first_name": "KYANA",
"middle_name": "MONIQUE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-14",
"last_updated": "2016-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C0003961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.