Individual provider Active NPI

Bethany A Correlli, FNP-BC

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1497353973
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AC003660 Issued in MD
Practice address
6635 Belair Rd
Baltimore, MD 21206-1845
Phone
(410) 254-9755
NPI assigned
Oct 15, 2020
Last updated
Jul 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AC003660 MD Primary
Primary Care Nurse Practitioner 363LP2300X 28225364A IN

Addresses

Primary practice location

6635 Belair Rd
Baltimore, MD 21206-1845

Mailing address

6635 Belair Rd
Baltimore, MD 21206-1845
Phone (410) 254-9755

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
I20210924000426 MD Practitioner - Nurse Practitioner 3274946033 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Care Center LLCGroup PAC ID 3274801139, 286 clinicians
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Practice addresses (Care Compare)

110 Baughmans LN
Suite 140
Frederick, MD 21702-4649
Phone (240) 215-1138

12 Newport Dr
Forest Hill, MD 21050-1758

301 Saint Paul St
Suite 409
Baltimore, MD 21202-2102
Phone (410) 659-7041

602 S Atwood Rd
Bel Air, MD 21014-4172
Phone (410) 515-6774

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28225364AINMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Menocal Medical Services PA Current Accepting new patients
Privia Care Center LLC CurrentSince Sep 22, 2024 Accepting new patients
Medstar Medical Group II LLC CurrentSince Mar 21, 2022 Accepting new patients
Privia Care Center LLC CurrentSince Sep 22, 2024 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

301 Saint Paul St
Ste 409
Baltimore, MD 21202
Phone (410) 659-7041

110 Baughmans Ln
Ste 140
Frederick, MD 21702
Phone (240) 215-1138

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

2000 15th St N
Ste 600
Arlington, VA 22201
Phone (202) 416-2000

Interoperability endpoints

  • Direct secure messaging: bethany.correlli.1@8042.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1497353973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6635 BELAIR RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212061845",
            "telephone_number": "410-254-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6635 BELAIR RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212061845",
            "telephone_number": "410-254-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORRELLI",
        "first_name": "BETHANY",
        "middle_name": "A",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-15",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC003660",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IN",
            "license": "28225364A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.