Individual provider Active NPI

Paul Kasemphantai, STUDENT

  • Physician Assistant
  • Washington, DC
National Provider Identifier
1790226181
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA031363 Issued in DC
Practice address
2041 Georgia Ave NW # 1
Washington, DC 20060-0001
Phone
(202) 865-1141
NPI assigned
Mar 17, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 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 C06509 MD
Physician Assistant 363A00000X PA031363 DC Primary

Addresses

Primary practice location

2041 Georgia Ave NW # 1
Washington, DC 20060-0001

Mailing address

257 Amberleigh Dr
Silver Spring, MD 20905-5992
Phone (301) 642-2101

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: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170803000417 DC Practitioner - Physician Assistant 6002187499 Reassigns benefits to 5 organizations
I20230214001091 MD Practitioner - Physician Assistant 6002187499 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA031363DCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Urgent Care LLC CurrentSince Jan 29, 2023 Accepting new patients
Cep America LLC CurrentSince Aug 1, 2017 Accepting new patients
Synergy Medical Group LLC CurrentSince May 12, 2024 Accepting new patients
Medstar Urgent Care LLC CurrentSince Jan 29, 2023 Accepting new patients
Cep America LLC CurrentSince Aug 1, 2017 Accepting new patients
Synergy Medical Group LLC CurrentSince May 12, 2024 Accepting new patients
Synergy Medical Group LLC CurrentSince May 12, 2024 Accepting new patients
Medstar Urgent Care LLC CurrentSince Jan 29, 2023 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2041 Georgia Ave NW
Washington, DC 20060
Phone (202) 865-3785

2041 Georgia Ave NW
#1
Washington, DC 20060
Phone (202) 865-1141

6317 York Rd
Baltimore, MD 21212
Phone (443) 777-6890

3210 Powder Mill Rd
Hyattsville, MD 20783
Phone (301) 937-3939

299 Hurley Ave
Rockville, MD 20850
Phone (301) 762-8900

1500 Forest Glen Rd
Silver Spring, MD 20910
Phone (301) 754-7230

1205 York Rd
Ste 11
Timonium, MD 21093
Phone (443) 325-0031

3064 Waldorf Market Pl
Waldorf, MD 20603
Phone (301) 932-5960

11915 Georgia Ave
Wheaton, MD 20902
Phone (301) 942-4505

2000 15th St N
Ste 600
Arlington, VA 22201
Phone (202) 425-0000

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1489708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1790226181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 AMBERLEIGH DR",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209055992",
            "telephone_number": "301-642-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 GEORGIA AVE NW # 1",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200600001",
            "telephone_number": "202-865-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASEMPHANTAI",
        "first_name": "PAUL",
        "credential": "STUDENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-17",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C06509",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA031363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.