Individual provider Active NPI

Irina Kapustina, M.D.

  • Diagnostic Radiology Physician
  • Baltimore, MD
National Provider Identifier
1720333842
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
D92422 Issued in MD
Practice address
22 S Greene St, Dept of Radiology
Baltimore, MD 21201-1544
Phone
(410) 328-3477
NPI assigned
Jul 14, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X D92422 MD Primary
Diagnostic Radiology Physician 2085R0202X 0420013819 VT

Addresses

Primary practice location

22 S Greene St, Dept of Radiology
Baltimore, MD 21201-1544

Mailing address

22 S Greene St, Dept of Radiology
Baltimore, MD 21201-1544
Phone (410) 328-3477

Other identifiers 2

IdentifierTypeStateIssuer
054773733MedicaidDC
999863200MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210902000695 DC Practitioner - Diagnostic Radiology 9335441260 Reassigns benefits to 1 organization
I20230608000524 VA Practitioner - Diagnostic Radiology 9335441260 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wayne State University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Meridian Medical LLCGroup PAC ID 5092766352, 17 clinicians

Practice addresses (Care Compare)

1554 River Birch Run N
Chesapeake, VA 23320-7500
Phone (757) 671-1144

676 Kingsborough SQ
Suite a
Chesapeake, VA 23320-4954
Phone (757) 965-4151

Merit-based Incentive Payment System (MIPS)

Final score
34.03 of 100Reported as group
Quality
22.39
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
First Meridian Medical LLC Diagnostic Radiology CurrentSince Jul 1, 2023 Accepting new patients
Chesapeake Diagnostic Imaging Centers, LLC Diagnostic Radiology CurrentSince Dec 1, 2024 Accepting new patients
First Meridian Medical LLC CurrentSince Jul 1, 2023 Accepting new patients
Chesapeake Diagnostic Imaging Centers, LLC Diagnostic Radiology CurrentSince Dec 1, 2024 Accepting new patients

Locations

1034 Battlefield Blvd S
Ste 110
Chesapeake, VA 23322
Phone (757) 671-1144

676 Kingsborough Sq
Ste A
Chesapeake, VA 23320
Phone (757) 547-4155

676 Kingsborough Sq
Chesapeake, VA 23320
Phone (757) 547-2472

1554 River Birch Run N
Chesapeake, VA 23320
Phone (757) 671-1144

171 Kempsville Rd
Bldg C
Norfolk, VA 23502
Phone (757) 671-8500

4668 Pembroke Blvd
Ste 117
Virginia Beach, VA 23455
Phone (757) 671-1144

596 Lynnhaven Pkwy
Ste 101
Virginia Beach, VA 23452
Phone (757) 671-1144

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1342224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1720333842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST, DEPT OF RADIOLOGY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST, DEPT OF RADIOLOGY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPUSTINA",
        "first_name": "IRINA",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-14",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D92422",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VT",
            "license": "0420013819",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054773733",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999863200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.