Individual provider Active NPI

Kelsey S Ivusich, AGACNP-BC

  • Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1912568148
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R186021 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1590
Phone
(410) 328-8141
Fax
(410) 328-0177
NPI assigned
Jun 27, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R186021 MD Primary

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1590

Mailing address

PO Box 64442
Baltimore, MD 21264-4442
Phone (410) 328-8040

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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190917000512 MD Practitioner - Nurse Practitioner 6709115736 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

201 E University Pkwy
Baltimore, MD 21218-2829
Phone (410) 554-2000

Hospital & facility affiliations

  • Medstar Union Memorial Hospital Hospital, Baltimore, MD, CCN 210024

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R186021MDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Physicians P.a. Current Accepting new patients
University of Maryland Physicians P.a. CurrentSince Aug 6, 2019 Accepting new patients
University of Maryland Physicians PA CurrentSince Aug 6, 2019 Accepting new patients
Medstar Medical Group II LLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

201 E University Pkwy
Baltimore, MD 21218
Phone (410) 554-2651

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

Organizations & group practices 4

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.

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": "1561593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1912568148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64442",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644442",
            "telephone_number": "410-328-8040",
            "fax_number": "443-462-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011590",
            "telephone_number": "410-328-8141",
            "fax_number": "410-328-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVUSICH",
        "first_name": "KELSEY",
        "middle_name": "S",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-27",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R186021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.