Kathleen Marie Eiseman-Brock – Clinical Social Worker

Key facts

NPI: 1841983160
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 08461 (MD)
Practice address: 3 Wagon Wheel CT
Glen Arm, MD 21057-9431
Phone: (410) 456-6149
NPI assigned: Jun 1, 2023
Sex: Female
Sole proprietor: Yes

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.

Supportive Care of Maryland LLC Psychologist · Riverdale, MD · NPI 1447802616

Medicare reassignment Care Compare group NPD DC · MD

Medicare Care Compare profile

Specialty: Clinical Social Worker
Education: Other, 1992
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Supportive Care of Maryland LLC (38 clinicians)

Practice addresses (Care Compare)

1010 E 33Rd St
Baltimore, MD 21218-3780
Phone 71829843753780

4409 E W Hwy
Riverdale, MD 20737-1058
Phone (718) 298-4375

Merit-based Incentive Payment System (MIPS)

Final score: 90.29 of 100 (group)
Quality: 73.37
Improvement activities: 40
Cost: 83.13

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in MD, DC
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20230629000102	MD	Practitioner - Clinical Social Worker	8224497979	Reassigns benefits to 1 organization
I20230629000193	DC	Practitioner - Clinical Social Worker	8224497979	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
08461	MD	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
Supportive Care of Maryland LLC		Current since Jun 1, 2023	Accepting new patients

Locations

4409 East West Hwy
Riverdale Park, MD 20737
Phone (301) 699-2000

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	08461	MD	Yes

Addresses

Primary practice location

3 Wagon Wheel CT
Glen Arm, MD 21057-9431

Mailing address

3 Wagon Wheel CT
Glen Arm, MD 21057-9431
Phone (410) 456-6149

Other names

Kathleen Marie Eiseman Former name

Other providers in Glen Arm, MD

All providers in Glen Arm, MD · Clinical Social Worker in Maryland

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.