Individual provider Active NPI

Lory Joy Estrella, CRNP

  • Family Nurse Practitioner
  • Frederick, MD
National Provider Identifier
1790400737
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R172030 Issued in MD
Practice address
196 Thomas Johnson Dr
Frederick, MD 21702-4397
Phone
(301) 242-3008
NPI assigned
Oct 11, 2022
Last updated
Oct 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 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 R172030 MD Primary

Addresses

Primary practice location

196 Thomas Johnson Dr
Frederick, MD 21702-4397

Mailing address

196 Thomas Johnson Dr
Frederick, MD 21702-4397
Phone (301) 242-3008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 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
I20230704000384 MD Practitioner - Nurse Practitioner 0749649192 Reassigns benefits to 1 organization
I20260520003955 DC Practitioner - Nurse Practitioner 0749649192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Praveen Bolarum MD LLCGroup PAC ID 9638276199, 5 clinicians
Amber Hill Physical Therapy IncGroup PAC ID 8527963917, 336 clinicians

Practice addresses (Care Compare)

10714 Potomac Tennis LN
Potomac, MD 20854-4418
Phone (301) 299-2273

187 Thomas Johnson Dr
Frederick, MD 21702-4503

196 Thomas Johnson Dr
Frederick, MD 21702-4518
Phone (301) 694-6688

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R172030MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Praveen Bolarum, MD LLC CurrentSince May 1, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

196 Thomas Johnson Dr
Ste 135
Frederick, MD 21702
Phone (301) 200-5639

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1790400737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024397",
            "telephone_number": "301-242-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024397",
            "telephone_number": "301-242-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTRELLA",
        "first_name": "LORY JOY",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R172030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

Verify at the official NPI Registry.