Individual provider Active NPI

Amanda Renae Crum, O.D, M.S

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1861704751
Registry record updated Jun 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2276 Issued in MD
Practice address
600 N Wolfe St
Baltimore, MD 21287-0005
Phone
(410) 614-5115
NPI assigned
Jul 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5961 OH
Optometrist 152W00000X TA2276 MD Primary

Addresses

Primary practice location

600 N Wolfe St
Baltimore, MD 21287-0005

Mailing address

PO Box 64481
Baltimore, MD 21264-4481
Phone (410) 614-5115

Other identifiers 1

IdentifierTypeStateIssuer
049414300MedicaidMD

Other names 1

  • Amanda Renae Marks Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120104000703 MD Practitioner - Optometry 2264565886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2010
Medicare assignment
May accept Medicare assignment
Group practices
Johns Hopkins UniversityGroup PAC ID 8921903147, 2,886 clinicians

Practice addresses (Care Compare)

10751 Falls Rd
Lutherville, MD 21093-4517
Phone (410) 955-3663

6201 Greenleigh Ave
Middle River, MD 21220-2004

Merit-based Incentive Payment System (MIPS)

Final score
83.31 of 100Reported as group
Quality
73.89
Promoting interoperability
100
Improvement activities
40
Cost
70.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
5961OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University Current Accepting new patients
Johns Hopkins University CurrentSince Nov 27, 2011 Accepting new patients
Johns Hopkins University Optometrist CurrentSince Nov 27, 2011 Accepting new patients

Locations

600 N Wolfe St
Baltimore, MD 21287

10751 Falls Rd
Timonium, MD 21093
Phone (410) 583-2727

Interoperability endpoints

  • Direct secure messaging: acrum17105@direct.hopkinsmedicine.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496966400000",
    "number": "1861704751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64481",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644481",
            "telephone_number": "410-614-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N WOLFE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870005",
            "telephone_number": "410-614-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUM",
        "first_name": "AMANDA",
        "middle_name": "RENAE",
        "name_prefix": "Dr.",
        "credential": "O.D, M.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-08",
        "last_updated": "2017-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5961",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "049414300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "MARKS",
            "middle_name": "RENAE",
            "credential": "O.D.,M.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.