Individual provider Active NPI

Susan B Lovelace, CRNP

  • Pediatric Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1679597876
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
R117678 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201
Phone
(410) 328-6749
Fax
(410) 328-6136
NPI assigned
Jul 27, 2006
Last updated
Jun 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X R117678 MD Primary
Pediatric Clinical & Laboratory Immunology Physician 2080I0007X R117678 MD

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201

Mailing address

PO Box 62063
Baltimore, MD 21264-2063
Phone (410) 706-5181

Other identifiers 1

IdentifierTypeStateIssuer
000290900MedicaidMD

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101227000791 MD Practitioner - Nurse Practitioner 6901094432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

22 S Green St
Baltimore, MD 21201-1544
Phone (410) 706-5181

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Pediatric Associates, PA CurrentSince Aug 2, 2010 Accepting new patients
University of Maryland Pediatric Associates, PA CurrentSince Aug 2, 2010 Accepting new patients

Locations

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

22 S Greene St
Fl 5
Baltimore, MD 21201
Phone (410) 328-5887

12500 Willowbrook Rd
Cumberland, MD 21502
Phone (240) 964-1255

Interoperability endpoints

  • Direct secure messaging: slovelace7450@direct.umm.edu

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1679597876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62063",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212642063",
            "telephone_number": "410-706-5181",
            "fax_number": "410-706-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "telephone_number": "410-328-6749",
            "fax_number": "410-328-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVELACE",
        "first_name": "SUSAN",
        "middle_name": "B",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R117678",
            "primary": true
        },
        {
            "code": "2080I0007X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Clinical & Laboratory Immunology",
            "state": "MD",
            "license": "R117678",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000290900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.