Active NPI
Kelly Distasio
- Physician Assistant
- Clinton, MD
National Provider Identifier
1801639554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110011392
- Practice address
- 7503 Surratts Rd
Clinton, MD 20735-3358 - Phone
- (301) 877-7202
- NPI assigned
- Jun 18, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110011392 | VA | Primary |
Addresses
Primary practice location
7503 Surratts Rd
Clinton, MD 20735-3358
Mailing address
7501 Surratts Rd
Pob Suite 303
Clinton, MD 20735-3362
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1851 N George Mason Dr
Suite 4C
Arlington, VA 22207-1953
3601 Eisenhower Ave
Suite 220
Alexandria, VA 22304-6457
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110011392 | VA | MD | Physician Assistant |
Organizations & group practices 1
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.
-
- Maternal & Fetal Medicine Physician
- Arlington, VA
- NPI 1144415480
DC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786665600000",
"number": "1801639554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7501 SURRATTS RD",
"address_2": "POB SUITE 303",
"city": "CLINTON",
"state": "MD",
"postal_code": "207353362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7503 SURRATTS RD",
"city": "CLINTON",
"state": "MD",
"postal_code": "207353358",
"telephone_number": "301-877-7202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTASIO",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-18",
"last_updated": "2026-08-14",
"certification_date": "2026-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110011392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.