Individual provider Active NPI

Somanegre Lydie Karine Kafando, CRNP

  • Acute Care Nurse Practitioner
  • Ellicott City, MD
National Provider Identifier
1932881760
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R199749 Issued in MD
Practice address
5234 Harvey LN
Ellicott City, MD 21043-6857
Phone
(410) 318-9087
NPI assigned
Aug 2, 2023
Last updated
Aug 2, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R199749 MD Primary

Addresses

Primary practice location

5234 Harvey LN
Ellicott City, MD 21043-6857

Mailing address

5234 Harvey LN
Ellicott City, MD 21043-6857
Phone (410) 318-9087

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
I20240522000095 MD Practitioner - Nurse Practitioner 7517309685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifebridge Orthopedic Specialists LLCGroup PAC ID 4082928098, 46 clinicians

Practice addresses (Care Compare)

5415 Old Court Rd
S04
Randallstown, MD 21133-5170
Phone (410) 701-4437

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R199749MDMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Orthopedic Specialists, LLC CurrentSince May 20, 2024 Accepting new patients
Sinai Hospital of Baltimore Inc Past Accepting new patients

Locations

2401 W Belvedere Ave
Baltimore, MD 21215

5415 Old Court Rd
Ste S04
Randallstown, MD 21133
Phone (410) 701-4437

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1690934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1932881760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5234 HARVEY LN",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436857",
            "telephone_number": "410-318-9087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5234 HARVEY LN",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436857",
            "telephone_number": "410-318-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAFANDO",
        "first_name": "SOMANEGRE",
        "middle_name": "LYDIE KARINE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-02",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R199749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.