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GRACEWAY HEALTH CARE LLC
NPI 1417779083
Internal Medicine in Clinton, MD

Active since October 25, 2024
9106 PINE VIEW LN, CLINTON, MD 20735(667) 300-8222 Get Directions Write a Review

NPPES record last updated: February 25, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 25, 2025, Nov 21, 2024 (2 updates tracked since 2024).

About Graceway Health Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRACEWAY HEALTH CARE LLC (NPI 1417779083) is a healthcare organization registered as an internal medicine in Clinton, Maryland and active in the NPI registry since October 2024. The organization lists Krystle D Brown, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1417779083
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameGRACEWAY HEALTH CARE LLC
Location Address9106 PINE VIEW LNClinton, MD 20735-3229
Mailing Address10259 Cabery RdEllicott City, MD 21042-1605 · (410) 870-9380
Phone(667) 300-8222
Organization SubpartNo
Authorized OfficialKrystle D BrownPractice Administrator · (410) 800-6251
Enumeration DateOctober 25, 2024
Last NPPES UpdateFebruary 25, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 25, 2025
✔ NPI 1417779083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
9106 PINE VIEW LN, Clinton, MD 20735
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Other Names 1

Other NameGraceway Health Care, Llc Clinton

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Graceway Health Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Graceway Health Care LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 2

Nurse Practitioner6
Internal Medicine5

Clinicians, nearest first (11)

Sharen Ayensu, FNP-BC
Nurse Practitioner
NPI 1952642357
13912 EDSALL ST
Upper Marlboro, MD 20772
(301) 613-5570
✔ PECOS✔ Accepts Medicare8.4 mi
Tadele Desalew, M.D.
Internal Medicine
NPI 1528226719
12070 OLD LINE CTR STE 207
Waldorf, MD 20602
(301) 609-6397
✔ PECOS✔ Accepts Medicare10 mi
Hannah Ngale
Nurse Practitioner
NPI 1386282937
7204 MORRISON DR
Greenbelt, MD 20770
(301) 512-0726
✔ PECOS✔ Accepts Medicare16 mi
Mesay Gebresilassie, NP
Nurse Practitioner
NPI 1568918472
11120 NEW HAMPSHIRE AVE SUITE 309
Silver Spring, MD 20904
(240) 991-2197
✔ PECOS✔ Accepts Medicare20 mi
Khawaja Farooq, MD
Internal Medicine
NPI 1447281308
2001 MEDICAL PARKWAY ACUTE CARE PAVILION
Annapolis, MD 21401
(443) 481-1000
✔ PECOS✔ Accepts Medicare25 mi
Benorayehush Weldetsadik, M.D.
Internal Medicine
NPI 1255579744
10710 CHARTER DR SUITE 310
Columbia, MD 21044
(410) 997-5944
✔ PECOS✔ Accepts Medicare31 mi
Addisu Temesgen, MD
Internal Medicine
NPI 1386971927
10259 CABERY RD
Ellicott City, MD 21042
(410) 870-9380
✔ PECOS✔ Accepts Medicare37 mi
Morenike Agboola, NP
Nurse Practitioner
NPI 1811469414
1232 RACE RD STE 403
Rosedale, MD 21237
(480) 878-7806
✔ PECOS✔ Accepts Medicare45 mi
Nwaebuni Okeke
Nurse Practitioner
NPI 1528594462
1311 S MAIN ST
Mount Airy, MD 21771
(571) 349-0920
✔ PECOS✔ Accepts Medicare45 mi
Yolanda Greene, CRNP
Nurse Practitioner
NPI 1073846382
11311 MCCORMICK RD STE 350
Hunt Valley, MD 21031
(443) 849-3184
✔ PECOS✔ Accepts Medicare52 mi
Ali Yahya, MD
Internal Medicine
NPI 1013934181
2213 STANLEY AVE SE
Roanoke, VA 24014
(571) 338-9463
✔ PECOS✔ Accepts Medicare197 mi

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 Graceway Health Care LLC's NPI number?

The NPI number for Graceway Health Care LLC is 1417779083. It was assigned to this organization in the NPPES registry on October 25, 2024. The provider is also known as Graceway Health Care, LLC Clinton.

Where is Graceway Health Care LLC located?

Graceway Health Care LLC is located at 9106 Pine View Ln, Clinton, MD 20735. The listed phone number is (667) 300-8222.

What is Graceway Health Care LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Graceway Health Care LLC enrolled in Medicare?

Yes. Graceway Health Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Graceway Health Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 2 Medicare specialties reassign their Medicare billing to Graceway Health Care 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 (6) and Internal Medicine (5). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Graceway Health Care LLC was last updated on February 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.