Individual provider Active NPI

Anthea S Kim, LCSWC

  • Clinical Social Worker
  • Silver Spring, MD
National Provider Identifier
1497051734
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
26816 Issued in MD
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

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210308000858 DC Practitioner - Clinical Social Worker 9638344922 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC50082548DCMDClinical Social Worker
26816MDMDClinical Social Worker
0904007400VAMDClinical Social Worker
1788COMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 2, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Current Accepting new patients
Psychcare Psychological Services, LLC CurrentSince Mar 1, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 2, 2021 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.

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

Verify at the official NPI Registry.