Kassandra A Dickens, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R163196 Issued in MD

Practice address

1417 Winter Pine TRL
Severn, MD 21144-1506

Phone

(301) 675-6471

Fax

(410) 832-5766

NPI assigned

Feb 18, 2011

Last updated

Sep 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mandm Behavioral Health SolutionsGroup PAC ID 1355634437, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• M&M Behavioral Health Solutions

  • Professional Counselor
  • Glen Burnie, MD
  • NPI 1134525710
  Medicare reassignment Care Compare group NPD
• Moral Peak Mental Health & Wellness, LLC.

  • Primary Care Clinic/Center
  • Severn, MD
  • NPI 1518625219
  Medicare reassignment NPD Authorized official
• Moral Peak Mental Health & Wellness, LLC.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Severn, MD
  • NPI 1265175293
  NPD Authorized official
• M&M Behavioral Health Solutions

  • Addiction (Substance Use Disorder) Counselor
  • Glen Burnie, MD
  • NPI 1508217449
  NPD

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1871890301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 WINTER PINE TRL",
            "city": "SEVERN",
            "state": "MD",
            "postal_code": "211441506",
            "telephone_number": "301-675-6471",
            "fax_number": "410-832-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 WINTER PINE TRL",
            "city": "SEVERN",
            "state": "MD",
            "postal_code": "211441506",
            "telephone_number": "301-675-6471",
            "fax_number": "410-832-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKENS",
        "first_name": "KASSANDRA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-18",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R163196",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R163196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EHP/PRIORITY PARTNERS",
            "identifier": "246893",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS OF MD",
            "identifier": "97285701",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00936839",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS BLUECHOICE",
            "identifier": "0114",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "553221300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "6602616",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "9115660",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Divine Healthcare
• Divine Healthcare
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• Psychiatric/Mental Health Nurse Practitioner in Severn, MD
• Providers in Severn, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.

Verify at the official NPI Registry.