KAISER PERMANENTE FREDERICK MED CTR NPI 1477618502

Pharmacy (Managed Care Organization Pharmacy) in Frederick, MD

NPI 1477618502 Organization Pharmacy Managed Care Organization Pharmacy CLIA Number 21D1060172 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

About KAISER PERMANENTE FREDERICK MED CTR

Kaiser Permanente Frederick Med Ctr is a provider established in Frederick, Maryland specializing in pharmacy (managed care organization pharmacy) . The NPI number of Kaiser Permanente Frederick Med Ctr is 1477618502 and was assigned on December 2006. The practitioner's primary taxonomy code is 3336M0003X. The provider is registered as an organization and their NPI record was last updated May 2021. The authorized official of this NPI record is Michelle Bonstalli Rph (Lead Pharmacist)

The CLIA number of Kaiser Permanente Frederick Med Ctr is 21D1060172 registered as a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to Kaiser Permanente Frederick Med Ctr in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1477618502

Provider NameKAISER PERMANENTE FREDERICK MED CTR
Provider Location Address7190 CRESTWOOD BLVD FREDERICK, MD 21703
Provider Mailing Address7190 CRESTWOOD BLVD FREDERICK, MD 21703
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date12-27-2006
Last Update Date05-26-2021


Primary Taxonomy

Taxonomy Code3336M0003X
ClassificationPharmacy
TypeSuppliers
SpecializationManaged Care Organization Pharmacy
Taxonomy DescriptionA pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only.

Business Address

KAISER PERMANENTE FREDERICK MED CTR
7190 CRESTWOOD BLVD
FREDERICK, MD
ZIP 21703
Phone: (240) 529-1800

Get Directions


Mailing Address

KAISER PERMANENTE FREDERICK MED CTR
7190 CRESTWOOD BLVD
FREDERICK, MD
ZIP 21703
Phone:



Authorized Official

Authorized Official Name MICHELLE BONSTALLI RPH
Authorized Official TitleLEAD PHARMACIST
Authorized Official Phone(240) 529-1800

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1477618502 is:

CLIA Number21D1060172
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
2133229OTHER (01)

Other Providers at the same location


The following 12 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1003008830MS. PAULA GRACE LCSW C
Individual
Social Worker (Clinical)7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(240) 529-1700
1972844702 DIANA ERIN MCDERMOTT PHARM. D
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1760723555 ANN LOUISE HALLOCK RPH
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1609010271DR. SOKPHEARY SRORN M.D.
Individual
Family Medicine7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(800) 777-7904
1245573427 SARAH KANG-PAK
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1437272150MRS. KIMBERLY DAWN WAGNER PHARM.D.
Individual
Pharmacist7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1194868422KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC
Organization
Pharmacy (Managed Care Organization Pharmacy)7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1800
1407999527KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC
Organization
Clinical Medical Laboratory7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1775
1548347065DR. SUSAN K LOVICH MD
Individual
Pediatrics7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(240) 529-1700
1932326709 ADEDOYIN SHONEKAN M.D.
Individual
Obstetrics & Gynecology7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1700
1972762995DR. LAINE MONTGOMERY CORNELISON MD
Individual
Family Medicine7190 CRESTWOOD BLVD KAISER PERMANENTE FREDERICK MEDICAL CENTER
FREDERICK, MD 21703
(240) 529-1700
1700237534 SEAN DAVID BOURNE MD
Individual
Family Medicine7190 CRESTWOOD BLVD
FREDERICK, MD 21703
(240) 529-1700

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.