Individual provider Active NPI

Kelly J Tanenholz, M.D.

  • Internal Medicine Physician
  • Rockville, MD
National Provider Identifier
1780688424
Registry record updated Feb 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0058604 Issued in MD
Practice address
1201 Seven Locks Rd
Ste 111
Rockville, MD 20854-2931
Phone
(301) 762-5020
Fax
(301) 294-7569
NPI assigned
Jun 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0058604 MD Primary

Addresses

Primary practice location

1201 Seven Locks Rd
Ste 111
Rockville, MD 20854-2931

Mailing address

PO Box 79632
Baltimore, MD 21279-0632
Phone (301) 762-5020

Other identifiers 1

IdentifierTypeStateIssuer
982841900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101028000200 DC Practitioner - Internal Medicine 7719083419 Reassigns benefits to 3 organizations
I20240709002901 MD Practitioner - Internal Medicine 7719083419 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Georgetown University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Care Center LLCGroup PAC ID 3274801139, 286 clinicians

Practice addresses (Care Compare)

1201 Seven Locks Rd
Suite 111
Rockville, MD 20854-2957
Phone (301) 762-5020

18121 Georgia Ave
Suite 103
Olney, MD 20832-1437
Phone (301) 762-5020

4910 Massachusetts Ave NW
Suite 114 Grady DC Office
Washington, DC 20016-4384
Phone (202) 686-0813

6410 Rockledge Dr
Bethesda, MD 20817-1844

Hospital & facility affiliations

  • Adventist Home Health Services, Inc. Home health agency, Silver Spring, MD, CCN 217032
  • Amedisys Home Health Care Home health agency, Largo, MD, CCN 217149
  • Bayada Home Health Care, Inc Home health agency, Gaithersburg, MD, CCN 217158
  • Sibley Memorial Hospital Hospital, Washington, DC, CCN 090005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0058604MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Feb 29, 2016 Accepting new patients
Capitol Cardiology Associates, LLC Current Accepting new patients
Bowie Internal Medicine Associates Internal Medicine CurrentSince Sep 2, 2002 Accepting new patients
Privia Care Center LLC Internal Medicine CurrentSince Oct 4, 2018 Accepting new patients
Menocal Medical Services PA Current Accepting new patients
Privia Care Center LLC Internal Medicine CurrentSince Oct 4, 2018 Accepting new patients
Privia Medical Group, LLC Internal Medicine CurrentSince Feb 29, 2016 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4910 Massachusetts Ave NW
Ste 114
Washington, DC 20016
Phone (202) 244-0812

301 Saint Paul St
Ste 409
Baltimore, MD 21202
Phone (410) 659-7041

14999 Health Center Dr
Ste 201
Bowie, MD 20716
Phone (301) 262-8188

110 Baughmans Ln
Ste 140
Frederick, MD 21702
Phone (240) 215-1138

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

1201 Seven Locks Rd
Ste 111
Rockville, MD 20854
Phone (301) 762-5020

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kelly.tanenholz.1@8042.direct.athenahealth.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423008000000",
    "number": "1780688424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79632",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212790632",
            "telephone_number": "301-762-5020",
            "fax_number": "301-309-3783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SEVEN LOCKS RD",
            "address_2": "STE 111",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208542931",
            "telephone_number": "301-762-5020",
            "fax_number": "301-294-7569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANENHOLZ",
        "first_name": "KELLY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-10",
        "last_updated": "2015-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0058604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "982841900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.