NPIMap

Individual provider Active NPI

Kimberly Sue Weiss, PA

  • Medical Physician Assistant
  • Clarksville, MD
National Provider Identifier
1376789859
Registry record updated Sep 12, 2025
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Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C0001240 Issued in MD
Practice address
6355 Ten Oaks Rd
Suite 202
Clarksville, MD 21029-1185
Phone
(410) 531-1440
Fax
(410) 531-1412
NPI assigned
Jan 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X C0001240 MD Primary

Addresses

Primary practice location

6355 Ten Oaks Rd
Suite 202
Clarksville, MD 21029-1185

Mailing address

2 University PLZ Ste 204
Hackensack, NJ 07601-6211
Phone (551) 295-8223

Other practice location 1

39 V St NE
Washington, DC 20002-1329
Phone (551) 295-8223

Other practice location 2

962 Wayne Ave Ste 250
Silver Spring, MD 20910-4433
Phone (551) 295-8223

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
I20160111000157 MD Practitioner - Physician Assistant 0143406165 Reassigns benefits to 4 organizations
I20250129000787 DC Practitioner - Physician Assistant 0143406165 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ennoble HC DMV LLCGroup PAC ID 9032517925, 112 clinicians

Practice addresses (Care Compare)

39 V St NE
Washington, DC 20002-1329
Phone (862) 812-9010

8115 Maple Lawn Blvd
Suite 350
Fulton, MD 20759-2683
Phone (973) 435-9463

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Community Physicians Inc CurrentSince Dec 31, 2015 Accepting new patients
Ennoble HC DMV III LLC CurrentSince Oct 27, 2025 Accepting new patients
Ennoble HC DMV II LLC CurrentSince Oct 16, 2025 Accepting new patients
Lifebridge Community Physicians, Inc CurrentSince Dec 31, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1500 K St NW
Fl 2
Washington, DC 20005
Phone (212) 287-4257

1500 K St NW
Ofc 226A
Washington, DC 20005
Phone (862) 812-9010

6355 Ten Oaks Rd
Ste 202
Clarksville, MD 21029
Phone (410) 531-1440

8115 Maple Lawn Blvd
Ste 350
Fulton, MD 20759
Phone (240) 744-0001

962 Wayne Ave
Ste 250
Silver Spring, MD 20910
Phone (240) 744-0001

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

2 University Plz
Ste 204
Hackensack, NJ 07601
Phone (201) 564-0142

Organizations & group practices 8

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": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1376789859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 UNIVERSITY PLZ STE 204",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016211",
            "telephone_number": "551-295-8223",
            "fax_number": "410-997-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6355 TEN OAKS RD",
            "address_2": "SUITE 202",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210291185",
            "telephone_number": "410-531-1440",
            "fax_number": "410-531-1412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 V St NE",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200021329",
            "country_code": "US",
            "telephone_number": "551-295-8223",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "962 Wayne Ave Ste 250",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209104433",
            "country_code": "US",
            "telephone_number": "551-295-8223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEISS",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-05",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0001240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, MD

Sources for this page

Verify at the official NPI Registry.