NPIMap

Organization Active NPI

Kennedy Krieger Associates

  • Pediatrics Physician
  • Fulton, MD
National Provider Identifier
1962211953
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KENNEDY KRIEGER ASSOCIATES
Practice address
11830 W Market PL Ste NQ
Fulton, MD 20759-2431
Phone
(443) 923-9327
NPI assigned
Jan 3, 2025
Organization subpart
Yes
Parent organization
KENNEDY KRIEGER ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

Name
Lisa Badie
Title
Vice President Finance
Phone
(443) 923-1812

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

11830 W Market PL Ste NQ
Fulton, MD 20759-2431

Mailing address

PO Box 45944
Baltimore, MD 21297-5944

Other identifiers 3

IdentifierTypeStateIssuer
168641100MedicaidMD
K631OtherMDBLUECROSS MARYLAND
F158OtherMDBLUECROSS FEDERAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031231000300 MD Part B Supplier - Clinic/Group Practice 1759280597 Receives reassigned benefits from 350 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Odenton, MD; Middle River, MD; Fulton, MD; Columbia, MD; Baltimore, MD

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Kennedy Krieger Associates15 organizations share this tax ID, including this one
Part of
Kennedy Krieger Associates

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1962211953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45944",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212975944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11830 W MARKET PL STE NQ",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592431",
            "telephone_number": "443-923-9327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY KRIEGER ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY KRIEGER ASSOCIATES",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "BADIE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "443-923-1812"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168641100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS MARYLAND",
            "identifier": "K631",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS FEDERAL",
            "identifier": "F158",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.