Individual provider Active NPI

Amy Lynne Banulis, MD

  • Obstetrics & Gynecology Physician
  • Washington, DC
National Provider Identifier
1730240920
Registry record updated May 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD035425 Issued in DC
Practice address
2100 Pennsylvania Ave NW
West End Medical Center
Washington, DC 20037-3202
Phone
(202) 872-7000
Fax
(202) 872-7212
NPI assigned
Dec 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X D63032 MD
Obstetrics & Gynecology Physician 207V00000X MD035425 DC Primary

Addresses

Primary practice location

2100 Pennsylvania Ave NW
West End Medical Center
Washington, DC 20037-3202

Mailing address

2101 E Jefferson St
Kaiser Permanente Medicare Enrollment
Rockville, MD 20852-4908
Phone (301) 816-6424

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

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
I20050721000596 DC Practitioner - Obstetrics/Gynecology 8123055167 Reassigns benefits to 4 organizations
I20190123004130 VA Practitioner - Obstetrics/Gynecology 8123055167 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD035425DCMDObstetrics & Gynecology Physician
D63032MDMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Jul 23, 2009 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Obstetrics & Gynecology CurrentSince Nov 19, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Obstetrics & Gynecology Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Jul 6, 2014 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Oct 20, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Nov 1, 2014 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Jul 23, 2009 Accepting new patients

Locations

2100 Pennsylvania Ave NW
Ste W
Washington, DC 20037
Phone (202) 721-2216

1011 N Capitol St NE
Washington, DC 20002
Phone (202) 898-5100

10810 Connecticut Ave
Kensington, MD 20895
Phone (301) 929-7100

1221 Mercantile Ln
Fl 3
Largo, MD 20774
Phone (301) 618-5500

655 Watkins Mill Rd
Montgomery Village, MD 20879
Phone (301) 929-7100

2101 E Jefferson St
Ste 6
Rockville, MD 20852

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

2101 E Jefferson St
Rockville, MD 20852
Phone (301) 816-6660

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

Organizations & group practices 7

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622419200000",
    "number": "1730240920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E JEFFERSON ST",
            "address_2": "KAISER PERMANENTE MEDICARE ENROLLMENT",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208524908",
            "telephone_number": "301-816-6424",
            "fax_number": "301-816-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 PENNSYLVANIA AVE NW",
            "address_2": "WEST END MEDICAL CENTER",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200373202",
            "telephone_number": "202-872-7000",
            "fax_number": "202-872-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANULIS",
        "first_name": "AMY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2021-05-31",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MD",
            "license": "D63032",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "DC",
            "license": "MD035425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2100 Pennsylvania Ave NW",
            "address_2": "West End Medical Center",
            "city": "Washington",
            "state": "DC",
            "country_code": "US",
            "postal_code": "200373202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.