Shirley Lin Pack, NURSE PRACTITIONER

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R199636 Issued in MD

Practice address

700 Summertime Dr
Odenton, MD 21113-1590

Phone

(410) 245-0210

NPI assigned

Jan 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Agnes Healthcare IncGroup PAC ID 9830092733, 265 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Agnes Hospital Hospital, Baltimore, MD, CCN 210011

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• St Agnes Healthcare Inc

  dba Integrated Specialists Group

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1144250176

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Seton Medical Group, Inc

  • Internal Medicine Physician
  • Columbia, MD
  • NPI 1144409194
  Medicare reassignment NPD
• St Agnes Healthcare Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1780615922
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Agnes Healthcare, Inc.

  dba St.Agnes Hospital

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1245274901
  Care Compare affiliation

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1619567906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SUMMERTIME DR",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131590",
            "telephone_number": "410-245-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SUMMERTIME DR",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131590",
            "telephone_number": "410-245-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "SHIRLEY",
        "middle_name": "LIN",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R199636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Orthopedic Physicians of Annapolis LLC (Orthopaedic and Sports Medicine Center)
• Orthopedic Physicians of Annapolis LLC
• Georgina Oti
• Adebukola Adenike Oyekan
• Chizoba Godwin Ozoude
• Serina Page
• Nina Paige
• Pama LLC
• Vidya Parawati, MOTR/L
• Michaela Pariso, LMSW

• Nurse Practitioner in Odenton, MD
• Providers in Odenton, MD by specialty
• Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.