Michele Phulsuksombati, MS, MED,RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DX3822 Issued in MD

Practice address

8200 Blue Heron Dr
2D
Frederick, MD 21701-9358

Phone

(301) 788-5392

NPI assigned

Sep 26, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Enrollment records 2

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, 1,921 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education, Master of Science

State licenses

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Annapolis, MD
  • NPI 1952461816

  DC

  Medicare reassignment Care Compare group NPD
• Food Frame of Mind

  • Registered Dietitian
  • Frederick, MD
  • NPI 1811656606

  Dietitian, Registered

  NPD Authorized official
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Gaithersburg, MD
  • NPI 1831471713
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1386014819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 BLUE HERON DR",
            "address_2": "2D",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217019358",
            "telephone_number": "301-788-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 BLUE HERON DR",
            "address_2": "2D",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217019358",
            "telephone_number": "301-788-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHULSUKSOMBATI",
        "first_name": "MICHELE",
        "credential": "MS, MED,RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-26",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "DX3822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "8200 Blue Heron Dr",
            "address_2": "2D",
            "city": "Frederick",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217019358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Philip J McGann MD,PA
• Hamblin Phillips
• Todd Phillips
• Phoenix Mental Health Counseling, LLC
• Phoenix Surgical Care LLC
• Physician'S Footwear
• Physiotherapy Associates Inc
• Yechen Pi
• John Dominic Piacentino, MD
• Wray Pardy Pianta, MMSC PT

• Registered Dietitian in Frederick, MD
• Providers in Frederick, MD by specialty
• Registered Dietitian in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.