NPIMap

Individual provider Active NPI

Kevin C Hackett, M.D.

  • Urology Physician
  • Hagerstown, MD
National Provider Identifier
1568419901
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
D47115 Issued in MD
Practice address
11110 Medical Campus Rd
Suite 228
Hagerstown, MD 21742-6700
Phone
(301) 733-0022
Fax
(301) 733-3461
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X D47115 MD Primary
Urology Physician 208800000X MD0550551 PA

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 228
Hagerstown, MD 21742-6700

Mailing address

PO Box 37813
Baltimore, MD 21297-7813
Phone (301) 733-0022

Other identifiers 1

IdentifierTypeStateIssuer
370801200MedicaidMD

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
I20081023000473 MD Practitioner - Urology 5294893376 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Georgetown University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11110 Medical Campus Rd
Suite 228
Hagerstown, MD 21742-6727
Phone (301) 790-9350

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
30 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D47115MDMDUrology Physician
MD0550551PAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Practices of Antietam LLC CurrentSince Sep 1, 2023 Accepting new patients
Medical Practices of Antietam, LLC CurrentSince Sep 1, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients

Locations

11110 Medical Campus Rd
Ste 228
Hagerstown, MD 21742
Phone (301) 733-0022

13620 Crayton Blvd
Hagerstown, MD 21742
Phone (240) 313-3100

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

11110 Medical Campus Rd
Hagerstown, MD 21742
Phone (240) 313-9800

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

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 10

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458604800000",
    "number": "1568419901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37813",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212977813",
            "telephone_number": "301-733-0022",
            "fax_number": "301-733-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 228",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-733-0022",
            "fax_number": "301-733-3461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKETT",
        "first_name": "KEVIN",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2016-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MD",
            "license": "D47115",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD0550551",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370801200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.