NPIMap

Individual provider Active NPI

Kerri V Ellinger, P.A.-C.

  • Physician Assistant
  • Salisbury, MD
National Provider Identifier
1376732917
Registry record updated Jan 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0002365 Issued in MD
Practice address
659 S Salisbury Blvd
Suite 4
Salisbury, MD 21801-5453
Phone
(410) 543-9111
Fax
(410) 543-9115
NPI assigned
Oct 19, 2007
Last updated
Jan 31, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0002365 MD Primary

Addresses

Primary practice location

659 S Salisbury Blvd
Suite 4
Salisbury, MD 21801-5453

Mailing address

8110 Maple Lawn Blvd Ste 235
Fulton, MD 20759-2694
Phone (301) 340-8339

Other identifiers 2

IdentifierTypeStateIssuer
357675ZC6DOtherMDMEDICARE ID
C0002365OtherMDSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140814000155 MD Practitioner - Physician Assistant 1456578566 Reassigns benefits to 4 organizations
I20210128001213 DC Practitioner - Physician Assistant 1456578566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidalhealth Specialty Care LLCGroup PAC ID 7113340845, 375 clinicians
Tidalhealth Atlantic IncGroup PAC ID 2365437837, 95 clinicians

Practice addresses (Care Compare)

100 E Carroll St
Salisbury, MD 21801-5422

12308 Ocean Gtwy
Ocean City, MD 21842-9341

6040 Public Landing Rd
Snow Hill, MD 21863-2453
Phone (410) 629-0041

9714 Healthway Dr
Berlin, MD 21811-1154
Phone (410) 641-3340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.2 of 100Reported as group
Quality
70.92
Promoting interoperability
98
Improvement activities
40
Cost
71.41

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0002365MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MNR Industries LLC Current Accepting new patients
MNR Industries, LLC CurrentSince Jan 3, 2021 Accepting new patients
Capital Women's Care, L.L.C. Current Accepting new patients
Tidalhealth Specialty Care, LLC CurrentSince Mar 1, 2026 Accepting new patients
MNR Industries, LLC CurrentSince Jan 3, 2021 Accepting new patients
Tidalhealth Atlantic, Inc. CurrentSince Nov 12, 2021 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1505 E Churchville Rd
Bel Air, MD 21014
Phone (410) 420-6970

1505 E Churchville Rd
#A
Bel Air, MD 21014
Phone (410) 420-6970

10026 Old Ocean City Blvd
Ste 1
Berlin, MD 21811

9714 Healthway Dr
Berlin, MD 21811
Phone (410) 641-2600

6000 Laurel Bowie Rd
Bowie, MD 20715
Phone (301) 383-0330

61 Thomas Johnson Dr
Frederick, MD 21702
Phone (301) 663-6171

8110 Maple Lawn Blvd
Ste 235
Fulton, MD 20759

504 E Ridgeville Blvd
#A
Mount Airy, MD 21771
Phone (301) 703-5452

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100

659 S Salisbury Blvd
Ste 4
Salisbury, MD 21801
Phone (410) 340-3993

6040 Public Landing Rd
Snow Hill, MD 21863
Phone (410) 629-0041

Interoperability endpoints

  • Direct secure messaging: kerriellinger@agh.allscriptsdirect.net

Organizations & group practices 10

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.

Hospital & facility affiliations 3

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": "1192752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548892800000",
    "number": "1376732917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8110 MAPLE LAWN BLVD STE 235",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592694",
            "telephone_number": "301-340-8339",
            "fax_number": "301-340-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "659 S SALISBURY BLVD",
            "address_2": "SUITE 4",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015453",
            "telephone_number": "410-543-9111",
            "fax_number": "410-543-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGER",
        "first_name": "KERRI",
        "middle_name": "V",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-19",
        "last_updated": "2019-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0002365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "357675ZC6D",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "C0002365",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.