NPIMap

Organization Active NPI

St. Agnes Healthcare, Inc.

  • Body Imaging Physician
  • Baltimore, MD
National Provider Identifier
1629389630
Registry record updated Feb 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
ST. AGNES HEALTHCARE, INC.
Doing business as
St. Agnes Professional Services
Practice address
900 Caton Ave
Baltimore, MD 21229-5201
Phone
(667) 234-2126
Fax
(667) 234-2947
NPI assigned
Jun 24, 2010
Organization subpart
Yes
Parent organization
ST. AGNES HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2016

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

Authorized official

Name
Mr. Keith Vander Kolk
Title
President/Ceo
Phone
(667) 234-2101

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

900 Caton Ave
Baltimore, MD 21229-5201

Mailing address

3585 Washington Blvd
Halethorpe, MD 21227-1676
Phone (667) 234-2126

Other names 1

  • St. Agnes Professional Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Seton Medical Group41 organizations share this tax ID, including this one
Part of
Seton Medical Group

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Locations

1001 Pine Heights Ave
Ste 205
Baltimore, MD 21229
Phone (410) 369-2000

3421 Benson Ave
Ste 210
Baltimore, MD 21227
Phone (410) 368-2700

4 E Rolling Xrds
Ste 110
Catonsville, MD 21228
Phone (410) 368-2600

6740 Alexander Bell Dr
Ste 302
Columbia, MD 21046
Phone (667) 234-2758

1010 Cromwell Bridge Rd
Towson, MD 21286
Phone (410) 825-5626

10711 Birmingham Way
Woodstock, MD 21163
Phone (410) 480-1895

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456358400000",
    "number": "1629389630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3585 WASHINGTON BLVD",
            "city": "HALETHORPE",
            "state": "MD",
            "postal_code": "212271676",
            "telephone_number": "667-234-2126",
            "fax_number": "667-234-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CATON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295201",
            "telephone_number": "667-234-2126",
            "fax_number": "667-234-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AGNES HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. AGNES HEALTHCARE, INC.",
        "enumeration_date": "2010-06-24",
        "last_updated": "2016-02-25",
        "status": "A",
        "authorized_official_last_name": "VANDER KOLK",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "667-234-2101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Agnes Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.