NPIMap

Individual provider Active NPI

Kathleen Prendergast, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Glen Burnie, MD
National Provider Identifier
1649260753
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
D0063787 Issued in MD
Practice address
300 Hospital Dr
Suite 119
Glen Burnie, MD 21061-6902
Phone
(410) 787-4940
NPI assigned
Oct 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X D0063787 MD Primary

Addresses

Primary practice location

300 Hospital Dr
Suite 119
Glen Burnie, MD 21061-6902

Mailing address

301 Hospital Dr
Glen Burnie, MD 21061-5803
Phone (410) 787-4594

Other identifiers 10

IdentifierTypeStateIssuer
62213902OtherMDCAREFIRST BLUE CROSS
108887OtherMDJOHNS HOPKINS HEALTH CARE
5831489OtherMDAETNA PPO
7973311OtherMDCIGNA
4987OtherMDBRAVO/ ELDER HEALTH
F591-0022OtherDCCAREFIRST BLUE CROSS
403539901MedicaidMD
194995OtherMDAMERIGROUP
3301092OtherMDUHC/AMERICHOICE
1080315OtherMDAETNA HMO

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
I20050915001135 MD Practitioner - Endocrinology 2163312513 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
State University of Ny Upstate Medical University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

301 Hospital Dr
Glen Burnie, MD 21061-5803
Phone (410) 787-4000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baltimore Washington Medical Center Inc. Current Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Baltimore Washington Medical Center Inc. Endocrinology, Diabetes & Metabolism CurrentSince Nov 1, 2005 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Baltimore Washington Medical Center Inc. CurrentSince Nov 1, 2005 Accepting new patients
Baltimore Washington Medical Center Inc. Endocrinology, Diabetes & Metabolism Current Accepting new patients
Washington Hospital Center PastSince Jan 1, 1990 Accepting new patients
Washington Hospital Center Corp PastSince Jan 1, 1990 Accepting new patients
Washington Hospital Center Corp PastSince Jan 1, 1990 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Arundel Physicians Associates, LLC Past Accepting new patients
Washington Hospital Center PastSince Jan 1, 1990 Accepting new patients

Locations

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

219 S Washington St
Easton, MD 21601

255 Hospital Dr
Ste 207
Glen Burnie, MD 21061
Phone (410) 443-8170

300 Hospital Dr
Ste 119
Glen Burnie, MD 21061
Phone (410) 553-8240

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

300 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4940

Interoperability endpoints

  • Direct secure messaging: kprendergast46036@direct.umm.edu

Organizations & group practices 12

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 3

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": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413417600000",
    "number": "1649260753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-787-4594",
            "fax_number": "410-787-4846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HOSPITAL DR",
            "address_2": "SUITE 119",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616902",
            "telephone_number": "410-787-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2014-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MD",
            "license": "D0063787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS",
            "identifier": "62213902",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHNS HOPKINS HEALTH CARE",
            "identifier": "108887",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "5831489",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7973311",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRAVO/ ELDER HEALTH",
            "identifier": "4987",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS",
            "identifier": "F591-0022",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403539901",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "194995",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC/AMERICHOICE",
            "identifier": "3301092",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "1080315",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.