Kathleen Cantwell Ackerman, M.D.
Individual provider Active NPI Psychosomatic Medicine Physician · Gaithersburg, MD
NPI 1730309501 · NPPES record last updated May 22, 2012
Key facts
- NPI
- 1730309501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychosomatic Medicine Physician 2084P0015X
- License
- D0027555 (MD)
- Practice address
- 610 E Diamond Ave
100A
Gaithersburg, MD 20877-5321 - Phone
- (301) 840-3200
- Fax
- (301) 840-1348
- NPI assigned
- Apr 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Diversified Counseling Services LLC
Practice addresses (Care Compare)
9135 Piscataway Rd
Clinton, MD 20735-2542
Phone (301) 856-3636
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080109000182 | DC | Practitioner - Psychiatry | 8628158698 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0027555 | MD | MD | Psychosomatic Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diversified Counseling Services, LLC | Current |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
9135 Piscataway Rd
Ste 220
Clinton, MD 20735
Phone (301) 856-3636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychosomatic Medicine Physician | 2084P0015X | D0027555 | MD | Yes |
Addresses
Primary practice location
610 E Diamond Ave
100A
Gaithersburg, MD 20877-5321
Mailing address
610 E Diamond Ave
100A
Gaithersburg, MD 20877-5321
Phone (301) 840-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 816700100 | Medicaid | MD |
Other providers in Gaithersburg, MD
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- Elia Enid Acevedo Diaz
- Act Health Integrated Services, LLC
- Activlife Medical Mobility
- Acucare Therapy, LLC
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All providers in Gaithersburg, MD · Psychosomatic Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.