Individual provider Active NPI

Kelli McCallum, CRNP

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1386022721
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R177915 Issued in MD
Practice address
1040 Park Ave Ste 200
Baltimore, MD 21201-5634
Phone
(443) 738-0300
NPI assigned
May 18, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R177915 MD Primary

Addresses

Primary practice location

1040 Park Ave Ste 200
Baltimore, MD 21201-5634

Mailing address

1040 Park Ave Ste 200
Baltimore, MD 21201-5634
Phone (443) 738-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160208000191 MD Practitioner - Nurse Practitioner 5294039590 Reassigns benefits to 2 organizations
I20160208000256 DC Practitioner - Nurse Practitioner 5294039590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

1145 19TH St NW
311 MMG at 19TH Street NW
Washington, DC 20036-3735
Phone (202) 429-2401

1805 Columbia Rd NW
MMG Adams Morgan
Washington, DC 20009-2001
Phone (202) 797-4950

23511 Hollywood Rd
Suite 2
Leonardtown, MD 20650-5833
Phone (301) 997-0611

3007 Tilden St NW
Suite 5N
Washington, DC 20008-3030

3800 Reservoir Rd NW
Washington, DC 20007-2113
Phone (703) 558-1400

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Mar 1, 2022 Accepting new patients
Medstar Medical Group II LLC Past Accepting new patients

Locations

1805 Columbia Rd NW
Washington, DC 20009
Phone (202) 797-4950

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

2114 Generals Hwy
Annapolis, MD 21401
Phone (410) 224-6483

3001 S Hanover St
Brooklyn Park, MD 21225
Phone (410) 350-3200

29955 Three Notch Rd
Ste 100
Charlotte Hall, MD 20622
Phone (301) 290-5300

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

23511 Hollywood Rd
Ste 2
Leonardtown, MD 20650
Phone (301) 997-0611

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1386022721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 PARK AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015634",
            "telephone_number": "443-738-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 PARK AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015634",
            "telephone_number": "443-738-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALLUM",
        "first_name": "KELLI",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-18",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R177915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.