Individual provider Active NPI

Alyssa Kjerulf, PA-C

  • Physician Assistant
  • Columbia, MD
National Provider Identifier
1730920026
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0009442 Issued in MD
Practice address
10710 Charter Dr Ste 130
Columbia, MD 21044-3258
Phone
(410) 772-7000
NPI assigned
Jun 3, 2024
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X C0009442 MD Primary

Addresses

Primary practice location

10710 Charter Dr Ste 130
Columbia, MD 21044-3258

Mailing address

10200 Grand Central Ave Ste 220
Owings Mills, MD 21117-4366

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
I20240716003219 MD Practitioner - Physician Assistant 0547705378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chesapeake Urology Associates LLCGroup PAC ID 4789673393, 161 clinicians

Practice addresses (Care Compare)

1838 Greene Tree Rd
Suite 460
Baltimore, MD 21208-7113
Phone (410) 581-8140

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0009442MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chesapeake Urology Associates LLC CurrentSince Aug 1, 2024 Accepting new patients
Chesapeake Urology Associates, LLC CurrentSince Aug 1, 2024 Accepting new patients
Chesapeake Urology Associates, LLC Past Accepting new patients

Locations

10710 Charter Dr
Ste 130
Columbia, MD 21044
Phone (301) 725-8880

10200 Grand Central Ave
Ste 220
Owings Mills, MD 21117

25 Crossroads Dr
Ste 306
Owings Mills, MD 21117
Phone (443) 231-1681

1838 Greene Tree Rd
Ste 460
Pikesville, MD 21208
Phone (410) 581-8140

Interoperability endpoints

  • Direct secure messaging: alyssakjerulf@tsicua.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1717372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1730920026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 GRAND CENTRAL AVE STE 220",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10710 CHARTER DR STE 130",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443258",
            "telephone_number": "410-772-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KJERULF",
        "first_name": "ALYSSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-03",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0009442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.