Individual provider Active NPI

Jannie Rene Kim, APRN

  • Primary Care Nurse Practitioner
  • Rockville, MD
National Provider Identifier
1417670290
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
R255370 Issued in MD
Practice address
7955 Tuckerman LN
Rockville, MD 20854-3243
Phone
(866) 389-2727
NPI assigned
Sep 26, 2022
Last updated
Oct 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X R255370 MD Primary

Addresses

Primary practice location

7955 Tuckerman LN
Rockville, MD 20854-3243

Mailing address

7955 Tuckerman LN
Rockville, MD 20854-3243
Phone (478) 335-6759

Other names 1

  • Jannie Rene Suratos Former name

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
I20221216001885 MD Practitioner - Nurse Practitioner 5395114128 Reassigns benefits to 1 organization
I20221219000753 DC Practitioner - Nurse Practitioner 5395114128 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Comprehensive Primary Care and Associates LLCGroup PAC ID 5092991984, 167 clinicians

Practice addresses (Care Compare)

15245 Shady Grove Rd
Suite 150
Rockville, MD 20850-7210
Phone (301) 869-9776

20410 Observation Dr
Suite 210
Germantown, MD 20876-6422
Phone (301) 869-9776

6410 Rockledge Dr
Bethesda, MD 20817-1844

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic LLC CurrentSince Nov 17, 2022 Accepting new patients
Comprehensive Primary Care and Associates LLC CurrentSince Apr 3, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2601 Riva Rd
Annapolis, MD 21401
Phone (410) 571-2090

10095 Ward Rd
Dunkirk, MD 20754
Phone (410) 257-0191

20410 Observation Dr
Ste 210
Germantown, MD 20876
Phone (301) 407-1466

15245 Shady Grove Rd
Ste 150
Rockville, MD 20850
Phone (667) 303-1042

15245 Shady Grove Rd
Ste 340
Rockville, MD 20850

15825 Shady Grove Rd
Ste 140
Rockville, MD 20850
Phone (301) 519-2118

7955 Tuckerman Ln
Rockville, MD 20854
Phone (301) 299-3717

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jannie.kim@cpcl.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1417670290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7955 TUCKERMAN LN",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208543243",
            "telephone_number": "478-335-6759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7955 TUCKERMAN LN",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208543243",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JANNIE",
        "middle_name": "RENE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R255370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JANNIE",
            "last_name": "SURATOS",
            "middle_name": "RENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.