NPIMap

Organization Active NPI

Bay Area Pediatrics, LLC

  • Pediatrics Physician
  • Stevensville, MD
National Provider Identifier
1760649958
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0041579 Issued in MD
Legal business name
BAY AREA PEDIATRICS, LLC
Practice address
165 Log Canoe Cir
Suite E
Stevensville, MD 21666-2149
Phone
(410) 643-1000
Fax
(410) 643-5200
NPI assigned
May 16, 2008
Last updated
May 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Authorized official

Name
Dr. Demetrios James Kalliongis, MDNPI 1831198944
Title
Physician Owner
Phone
(410) 643-2275

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0041579 MD Primary

Addresses

Primary practice location

165 Log Canoe Cir
Suite E
Stevensville, MD 21666-2149

Mailing address

165 Log Canoe Cir
Suite E
Stevensville, MD 21666-2149
Phone (410) 643-1000

Other identifiers 1

IdentifierTypeStateIssuer
407327400MedicaidMD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D1040404Bay Area Pediatrics165 Log Canoe Circle Ste E, Stevensville, MD 21666Certificate of waiverMay 8, 2027

National Provider Directory

National Provider Directory

Locations

165 Log Canoe Cir
Ste E
Stevensville, MD 21666
Phone (410) 643-1000

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1760649958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 LOG CANOE CIR",
            "address_2": "SUITE E",
            "city": "STEVENSVILLE",
            "state": "MD",
            "postal_code": "216662149",
            "telephone_number": "410-643-1000",
            "fax_number": "410-643-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 LOG CANOE CIR",
            "address_2": "SUITE E",
            "city": "STEVENSVILLE",
            "state": "MD",
            "postal_code": "216662149",
            "telephone_number": "410-643-1000",
            "fax_number": "410-643-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "KALLIONGIS",
        "authorized_official_first_name": "DEMETRIOS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "410-643-2275",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0041579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407327400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevensville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.