NPIMap

Individual provider Active NPI

Michelle Marie Skinner, D.O.

  • Family Medicine Physician
  • Gambrills, MD
National Provider Identifier
1497076814
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2747 Issued in WV
Practice address
2401 Brandermill Blvd
Gambrills, MD 21054-1690
Phone
(410) 721-1507
Fax
(410) 721-1510
NPI assigned
Jun 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2747 WV Primary

Addresses

Primary practice location

2401 Brandermill Blvd
Gambrills, MD 21054-1690

Mailing address

PO Box 12622
Belfast, ME 04915-4017
Phone (443) 481-6576

Other identifiers 1

IdentifierTypeStateIssuer
3810026534MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150721002736 MD Practitioner - Family Practice 8426296591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
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)

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Jul 1, 2015 Accepting new patients
Luminis Health Medical Group, LLC Current Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jul 1, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
University Healthcare Physicians, Inc. Family Medicine Past Accepting new patients

Locations

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: mskinner34296@direct.aahs.org

Organizations & group practices 5

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 6

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": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442275200000",
    "number": "1497076814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12622",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154017",
            "telephone_number": "443-481-6576",
            "fax_number": "443-481-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 BRANDERMILL BLVD",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541690",
            "telephone_number": "410-721-1507",
            "fax_number": "410-721-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKINNER",
        "first_name": "MICHELLE",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-21",
        "last_updated": "2015-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "2747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810026534",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gambrills, MD

Sources for this page

Verify at the official NPI Registry.