NPIMap

Individual provider Active NPI

Krishnaj Gourab

  • Physical Medicine & Rehabilitation Physician
  • Gwynn Oak, MD
National Provider Identifier
1538394242
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
D76155 Issued in MD
Practice address
2200 Kernan Dr
Gwynn Oak, MD 21207-6665
Phone
(410) 550-1715
NPI assigned
May 26, 2009
Last updated
Mar 22, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X D76155 MD Primary
Clinical Informatics Physician 2083C0008X D76155 MD

Addresses

Primary practice location

2200 Kernan Dr
Gwynn Oak, MD 21207-6665

Mailing address

2200 Kernan Dr
Gwynn Oak, MD 21207-6665
Phone (410) 448-6895

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
I20130628000299 MD Practitioner - Physical Medicine and Rehabilitation 8325288186 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2200 Kernan Dr
Gwynn Oak, MD 21207-6665
Phone (410) 448-2500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.26 of 100Reported as group
Quality
81.56
Promoting interoperability
100
Improvement activities
40
Cost
69.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D76155MDMDClinical Informatics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Jul 1, 2013 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Sep 22, 2021 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Sep 22, 2021 Accepting new patients
Johns Hopkins University Physical Medicine & Rehabilitation CurrentSince Jul 1, 2013 Accepting new patients
Johns Hopkins University Current Accepting new patients
Mt Washington Pediatric Hospital Inc PastSince Jul 1, 2023 Accepting new patients

Locations

5501 Hopkins Bayview Cir
Baltimore, MD 21224
Phone (410) 550-0545

600 N Wolfe St
Baltimore, MD 21287

2540 Centreville Rd
Centreville, MD 21617
Phone (410) 758-4432

301 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4565

920 Elkridge Landing Rd
Fl 4
Linthicum Heights, MD 21090
Phone (443) 462-5010

2200 Kernan Dr
Woodlawn, MD 21207
Phone (410) 448-2500

Interoperability endpoints

  • Direct secure messaging: kgourab525572@direct.umm.edu

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
University of Maryland Rehabilitation and Orthopaedic InstituteBaltimore, MD, CCN 210058 Hospital Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Mar 1, 2018
Mar 1, 2018
Mar 1, 2018
Mt Washington Physicians GroupBaltimore, MD, CCN 213300 Hospital Corporate Director Jul 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 2

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": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1538394242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 KERNAN DR",
            "city": "GWYNN OAK",
            "state": "MD",
            "postal_code": "212076665",
            "telephone_number": "410-448-6895",
            "fax_number": "410-448-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 KERNAN DR",
            "city": "GWYNN OAK",
            "state": "MD",
            "postal_code": "212076665",
            "telephone_number": "410-550-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURAB",
        "first_name": "KRISHNAJ",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "D76155",
            "primary": true
        },
        {
            "code": "2083C0008X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Clinical Informatics",
            "state": "MD",
            "license": "D76155",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gwynn Oak, MD

Sources for this page

Verify at the official NPI Registry.