Individual provider Active NPI

Erin Kenawell, CRNP

  • Family Nurse Practitioner
  • Gambrills, MD
National Provider Identifier
1386111763
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R208025 Issued in MD
Practice address
2401 Brandermill Blvd Ste 250
Gambrills, MD 21054-1668
Phone
(410) 721-1507
Fax
(410) 721-1510
NPI assigned
Oct 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 R208025 MD Primary

Addresses

Primary practice location

2401 Brandermill Blvd Ste 250
Gambrills, MD 21054-1668

Mailing address

2401 Brandermill Blvd Ste 250
Gambrills, MD 21054-1668
Phone (410) 721-1507

Other identifiers 1

IdentifierTypeStateIssuer
14461859MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190218000578 MD Practitioner - Nurse Practitioner 4385982073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

2401 Brandermill Blvd
Suite 250
Gambrills, MD 21054-1668
Phone (410) 721-1507

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R208025MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince May 10, 2020 Accepting new patients
Luminis Health Medical Group, LLC Current Accepting new patients
Luminis Health Medical Group, LLC CurrentSince May 10, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2003 Medical Pkwy
Ste 100
Annapolis, MD 21401
Phone (410) 573-1110

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2401 Brandermill Blvd
Ste 250
Gambrills, MD 21054
Phone (410) 721-1507

Interoperability endpoints

  • Direct secure messaging: ebooth108850@direct.aahs.org

Organizations & group practices 4

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 2

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": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1386111763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 BRANDERMILL BLVD STE 250",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541668",
            "telephone_number": "410-721-1507",
            "fax_number": "410-721-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 BRANDERMILL BLVD STE 250",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541668",
            "telephone_number": "410-721-1507",
            "fax_number": "410-721-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENAWELL",
        "first_name": "ERIN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-24",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R208025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14461859",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gambrills, MD

Sources for this page

Verify at the official NPI Registry.