Individual provider Active NPI

Constance Wantling, CRNP

  • Family Nurse Practitioner
  • Frederick, MD
National Provider Identifier
1528110137
Registry record updated Aug 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R152452 Issued in MD
Practice address
56 Thomas Johnson Dr
Frederick, MD 21702-4599
Phone
(301) 694-3111
Fax
(301) 694-8626
NPI assigned
Jan 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R152452 MD Primary

Addresses

Primary practice location

56 Thomas Johnson Dr
Frederick, MD 21702-4599

Mailing address

610 Solarex Court
Frederick, MD 21703

Other identifiers 2

IdentifierTypeStateIssuer
926580503MedicaidMD
926580505MedicaidMD

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
I20120515000311 MD Practitioner - Nurse Practitioner 4587827316 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Maryland School of Medicine, 1998
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

Practice addresses (Care Compare)

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

56 Thomas Johnson Dr
Frederick, MD 21702-4599
Phone (301) 694-3111

610 Solarex CT
Frederick, MD 21703-8624
Phone (301) 682-5500

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Care Center LLC CurrentSince Nov 5, 2018 Accepting new patients
Privia Care Center LLC Current Accepting new patients
Menocal Medical Services PA Current Accepting new patients
Privia Medical Group, LLC CurrentSince Nov 10, 2016 Accepting new patients
Privia Medical Group, LLC CurrentSince Nov 10, 2016 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

133 Defense Hwy
Ste 112
Annapolis, MD 21401
Phone (410) 573-0140

610 Solarex Ct
Frederick, MD 21703
Phone (301) 663-6162

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

56 Thomas Johnson Dr
Ste 200
Frederick, MD 21702
Phone (301) 694-3111

56 Thomas Johnson Dr
Frederick, MD 21702
Phone (301) 662-3660

610 Solarex Ct
#2
Frederick, MD 21703

11350 Pembrooke Sq
Ste 304
Waldorf, MD 20603
Phone (301) 856-2810

950 N Glebe Rd
Ste 4000
Arlington, VA 22203
Phone (301) 593-9011

Interoperability endpoints

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

Organizations & group practices 7

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": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470096000000",
    "number": "1528110137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 SOLAREX COURT",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 THOMAS JOHNSON DR",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024599",
            "telephone_number": "301-694-3111",
            "fax_number": "301-694-8626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANTLING",
        "first_name": "CONSTANCE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2016-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R152452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "926580503",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "926580505",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

Verify at the official NPI Registry.