NPIMap

Individual provider Active NPI

Kevin Lee Stitely, MD

  • Vascular Surgery Physician
  • Easton, MD
National Provider Identifier
1669453742
Registry record updated Dec 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
D48064 Issued in MD
Practice address
29466 Pintail Dr
Suite 6
Easton, MD 21601-9323
Phone
(410) 822-4220
Fax
(410) 822-4462
NPI assigned
Nov 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X D48064 MD Primary

Addresses

Primary practice location

29466 Pintail Dr
Suite 6
Easton, MD 21601-9323

Mailing address

PO Box 12622
Belfast, ME 04915-4017
Phone (443) 481-6538

Other identifiers 3

IdentifierTypeStateIssuer
852121200MedicaidMD
E4810003OtherMDCAREFIRST BLUECHOICE
232884OtherMDMAMSI

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
I20070611000650 MD Practitioner - General SurgeryPractitioner - Vascular Surgery 8527166743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Vascular Surgery
Education
University of Pittsburgh School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

29466 Pintail Dr
Suite 6
Easton, MD 21601-9324
Phone (410) 822-4220

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)17
Hernia repair (minimally invasive)1-10
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Sep 1, 2012 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Sep 1, 2012 Accepting new patients
Luminis Health Medical Group, LLC Current Accepting new patients
Shore Surgical Group PA Past Accepting new patients

Locations

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2000 Medical Pkwy
Ste 510
Annapolis, MD 21401
Phone (443) 481-4600

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

2000 Medical Pkwy
Cpe St Claire, MD 21401
Phone (443) 481-3400

505 Dutchmans Ln
Bldg B
Easton, MD 21601
Phone (410) 822-4553

555 Cynwood Dr
Easton, MD 21601
Phone (410) 810-0767

29466 Pintail Dr
Ste 6
Easton, MD 21601
Phone (410) 822-4220

Interoperability endpoints

  • Direct secure messaging: kstitely24724@direct.aahs.org

Organizations & group practices 4

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 5

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": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386460800000",
    "number": "1669453742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12622",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154017",
            "telephone_number": "443-481-6538",
            "fax_number": "443-481-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29466 PINTAIL DR",
            "address_2": "SUITE 6",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216019323",
            "telephone_number": "410-822-4220",
            "fax_number": "410-822-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STITELY",
        "first_name": "KEVIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2013-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MD",
            "license": "D48064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852121200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECHOICE",
            "identifier": "E4810003",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "232884",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, MD

Sources for this page

Verify at the official NPI Registry.