NPIMap

Organization Active NPI

Graceway Health Care LLC

  • Internal Medicine Physician
  • Clinton, MD
National Provider Identifier
1760239198
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRACEWAY HEALTH CARE LLC
Practice address
9211 Stuart LN
Clinton, MD 20735-2712
Phone
(301) 868-3600
NPI assigned
May 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Krystle D Brown
Title
Billing Manager
Phone
(410) 870-9380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9211 Stuart LN
Clinton, MD 20735-2712

Mailing address

10259 Cabery Rd
Ellicott City, MD 21042-1605
Phone (410) 870-9380

Other names 1

  • Graceway Healthcare CHC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221005002859 DC Part B Supplier - Clinic/Group Practice 9537544648 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, MD

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Graceway Health Care LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

9211 Stuart Ln
Clinton, MD 20735
Phone (301) 868-3600

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1714694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1760239198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10259 CABERY RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210421605",
            "telephone_number": "410-870-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9211 STUART LN",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352712",
            "telephone_number": "301-868-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEWAY HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-03",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "410-870-9380"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceway Healthcare CHC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Graceway Healthcare CHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.