Mark J Krist, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

31210 Issued in MD

Practice address

Usameddac
2480 Llewellyn Ave
Fort George G Meade, MD 20755

Phone

(301) 677-8136

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, NM, DC3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, DC, MI, NM

  Medicare reassignment NPD
• Child and Family Services of the Upper Peninsula Inc

  • Community/Behavioral Health Agency
  • Marquette, MI
  • NPI 1568714616
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1508884370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 RUTTER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212174136",
            "telephone_number": "646-691-7790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USAMEDDAC",
            "address_2": "2480 LLEWELLYN AVE",
            "city": "FORT GEORGE G MEADE",
            "state": "MD",
            "postal_code": "20755",
            "telephone_number": "301-677-8136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7610 Carroll Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Takoma Park",
            "state": "MD",
            "postal_code": "209126315",
            "country_code": "US",
            "telephone_number": "240-531-2891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRIST",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801085533",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-09359",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "31210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean B Kim, RN
• Kimbrough Amblatory Care Center
• Kimbrough Ambulatory Care Center
• Casey Kara King, LCSW-C
• Laura Anne Kocan, MS, CCC-SLP
• Darlene E Kuroda
• Janna Lambson, O.D.
• Angela Kathleen Lang, MS, RD, LDN, CDCES
• Marcia A Lang, PSYD LCSWC
• Joni Marie Larrabee, PHARMD

• Clinical Social Worker in Fort George G Meade, MD
• Providers in Fort George G Meade, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.

Verify at the official NPI Registry.