KRYSTAL MEDICAL ASSOCIATES LLC
NPI 1164604187
Clinic/Center - Primary Care in Glenn Dale, MD
About Krystal Medical Associates Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KRYSTAL MEDICAL ASSOCIATES LLC (NPI 1164604187), doing business as Krystal Medical Associates, is a healthcare organization registered as a primary care in Glenn Dale, Maryland and active in the NPI registry since November 2007. The organization maintains a secondary practice location in Washington and lists Nwaehihie Harrison Onyeaghala, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Secondary Practice Location 1
Other Identifiers 4
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Krystal Medical Associates Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Krystal Medical Associates LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Krystal Medical Associates LLC's NPI number?
The NPI number for Krystal Medical Associates LLC is 1164604187. It was assigned to this organization in the NPPES registry on November 30, 2007. The provider is doing business as Krystal Medical Associates.
Where is Krystal Medical Associates LLC located?
Krystal Medical Associates LLC is located at 12150 Annapolis Rd Ste 100, Glenn Dale, MD 20769. The listed phone number is (301) 464-7601.
What is Krystal Medical Associates LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Krystal Medical Associates LLC enrolled in Medicare?
Yes. Krystal Medical Associates LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Krystal Medical Associates LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Krystal Medical Associates LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (5) and Internal Medicine (1). Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Krystal Medical Associates LLC was last updated on September 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 52 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Krystal Medical Associates Llc · NPI 1164604187
Primary Care organization in Glenn Dale, Maryland. Organization record, active in the CMS NPPES registry since November 30, 2007.
## Identity
- **NPI:** 1164604187 (Entity type: Organization)
- **Enumerated:** November 30, 2007
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Also known as:** Krystal Medical Associates (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Nwaehihie Onyeaghala, OWNER
## Practice location
- **Address:** 12150 ANNAPOLIS RD STE 100, Glenn Dale, MD 20769-9183
- **Phone:** (301) 464-7601 · **Fax:** (866) 885-9817
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (5), Internal Medicine (1); 4 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 4, 2026
- **Other identifiers:** Medicaid 034934800 (DC); Medicaid 010012902 (VA); Medicaid 402647100 (MD); and 1 more
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Source: [NPI Profile](https://npiprofile.com/npi/1164604187) · Data from the CMS NPPES public registry.