Active NPI
Susan Demetrides, CPNP
- Pediatric Nurse Practitioner
- Baltimore, MD
National Provider Identifier
1356498786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R065937
- Practice address
- 707 N Broadway
Baltimore, MD 21205-1832 - Phone
- (443) 923-9200
- Fax
- (443) 923-9405
- NPI assigned
- Jan 5, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R065937 | MD | Primary |
Addresses
Primary practice location
707 N Broadway
Baltimore, MD 21205-1832
Mailing address
2931 E Biddle St
Baltimore, MD 21213-3939
Phone (443) 923-1886
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61114301 | Other | MD | CARE FIRST BC BS |
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)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R065937 | MD | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- sdemetrides150588@direct.hopkinsmedicine.org
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 and National Provider Directory roles.
-
- 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": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356498786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2931 E BIDDLE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212133939",
"telephone_number": "443-923-1886",
"fax_number": "443-923-1895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 N BROADWAY",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212051832",
"telephone_number": "443-923-9200",
"fax_number": "443-923-9405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMETRIDES",
"first_name": "SUSAN",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MD",
"license": "R065937",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE FIRST BC BS",
"identifier": "61114301",
"state": "MD"
}
],
"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 Jul 8, 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.