Active NPI
Anthea S Kim, LCSWC
- Clinical Social Worker
- Silver Spring, MD
National Provider Identifier
1497051734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 26816
- Practice address
- 12501 Prosperity Dr Ste 310
Silver Spring, MD 20904-1699 - Phone
- (571) 641-9109
- NPI assigned
- Feb 3, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904007400 | VA | |
| Clinical Social Worker | 1041C0700X | 1788 | CO | |
| Clinical Social Worker | 1041C0700X | LC50082548 | DC | |
| Clinical Social Worker | 1041C0700X | 26816 | MD | Primary |
Addresses
Primary practice location
12501 Prosperity Dr Ste 310
Silver Spring, MD 20904-1699
Mailing address
12501 Prosperity Dr Ste 310
Silver Spring, MD 20904-1699
Phone (240) 780-8884
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50082548 | DC | MD | Clinical Social Worker |
| 26816 | MD | MD | Clinical Social Worker |
| 0904007400 | VA | MD | Clinical Social Worker |
| 1788 | CO | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients | |
| Psychcare Psychological Services, LLC | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients |
Locations
2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853
12501 Prosperity Dr
Ste 310
Silver Spring, MD 20904
Phone (240) 780-8884
1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500
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.
-
- Health Maintenance Organization
- Annapolis, MD
- NPI 1952461816
DC
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Rockville, MD
- NPI 1962108753
-
- Clinical Psychologist
- Silver Spring, MD
- NPI 1831529767
-
- Health Maintenance Organization
- MC Lean, VA
- NPI 1376815472
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631664000000",
"number": "1497051734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12501 PROSPERITY DR STE 310",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209041699",
"telephone_number": "240-780-8884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12501 PROSPERITY DR STE 310",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209041699",
"telephone_number": "571-641-9109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ANTHEA",
"middle_name": "S",
"credential": "LCSWC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-03",
"last_updated": "2021-09-15",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904007400",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "1788",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50082548",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "26816",
"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": "C-CDA",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "12501 Prosperity Dr Ste 310",
"city": "Silver Spring",
"state": "MD",
"country_code": "US",
"postal_code": "209041699",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.