Individual provider Active NPI

Diana Lynn Passwaters, CRNP

  • Family Nurse Practitioner
  • Columbia, MD
National Provider Identifier
1770631996
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R125725 Issued in MD
Practice address
5457 Twin Knolls Rd Ste 100
Columbia, MD 21045-3263
Phone
(410) 689-7400
NPI assigned
Jan 5, 2007
Last updated
Aug 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R125725 MD Primary

Addresses

Primary practice location

5457 Twin Knolls Rd Ste 100
Columbia, MD 21045-3263

Mailing address

6400 Shafer CT Ste 700
Rosemont, IL 60018-4989
Phone (346) 376-1702

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
I20210818002429 MD Practitioner - Nurse Practitioner 8921226747 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Maryland School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seasons Medical Group of Maryland PCGroup PAC ID 9638321862, 10 clinicians

Practice addresses (Care Compare)

5457 Twin Knolls Rd
Suite 100
Columbia, MD 21045-3259
Phone (410) 689-7400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R125725MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Seasons Medical Group of Maryland PC CurrentSince Aug 22, 2022 Accepting new patients

Locations

6400 Shafer Ct
Ste 700
Rosemont, IL 60018

7520 Surratts Rd
Clinton, MD 20735
Phone (301) 856-1600

5457 Twin Knolls Rd
Ste 100
Columbia, MD 21045
Phone (410) 689-7400

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1770631996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 SHAFER CT STE 700",
            "city": "ROSEMONT",
            "state": "IL",
            "postal_code": "600184989",
            "telephone_number": "346-376-1702",
            "fax_number": "224-532-2780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5457 TWIN KNOLLS RD STE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210453263",
            "telephone_number": "410-689-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASSWATERS",
        "first_name": "DIANA",
        "middle_name": "LYNN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R125725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.