Adr LLC
Organization Active NPI Specialist · Cumberland, MD
NPI 1982607933 · NPPES record last updated Aug 16, 2010
Key facts
- NPI
- 1982607933
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- ADR LLC
- Practice address
- 952 Seton Dr
Cumberland, MD 21502-1950 - Phone
- (301) 777-3522
- Fax
- (301) 777-1902
- NPI assigned
- May 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Jong K Kim, MD
- Title
- President
- Phone
- (301) 724-1646
Practitioners 5
-
Jong K Kim, M.D.
-
Myung-Sup Kim, M.D.
-
Pradeep Kumar Kulkarni, M.D.
-
Judith Ann Smith, FNP-BC
-
Baljeet Singh Mahal, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040323000632 | MD | Part B Supplier - Clinic/Group Practice | 6608767256 |
Receives reassigned benefits from 5 practitioners Practice locations: Cumberland, MD |
| O20250627002414 | VA | Part B Supplier - Clinic/Group Practice | 6608767256 |
Receives reassigned benefits from 1 practitioner Practice locations: Ashburn, VA |
National Provider Directory
Locations
12252 Williams Rd SE
Ste 102
Cumberland, MD 21502
Phone (301) 777-3522
952 Seton Dr
Ste 210
Cumberland, MD 21502
Phone (301) 697-7221
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
952 Seton Dr
Cumberland, MD 21502-1950
Mailing address
PO Box 808
Cumberland, MD 21501-0808
Phone (301) 724-1646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001586989 | Other | WV | MT ST BS |
| 403741300 | Medicaid | MD | |
| J249 | Other | MD | MD BLUE SHIELD |
| 0201927000 | Medicaid | WV | |
| 216A | Other | MD | MD BLUE SHIELD |
| DA5555 | Other | RAILROAD MEDICARE |
Other providers in Cumberland, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.