BALTIMORE KETAMINE CLINIC
NPI 1972145381
Nurse Practitioner - Psychiatric/Mental Health in Sparks Glencoe, MD
About Baltimore Ketamine Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BALTIMORE KETAMINE CLINIC (NPI 1972145381) is a healthcare organization registered as a psychiatric/mental health in Sparks Glencoe, Maryland and active in the NPI registry since October 2019. The organization lists Ivana Mitic, Group Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Baltimore Ketamine Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Baltimore Ketamine Clinic, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
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 Baltimore Ketamine Clinic's NPI number?
The NPI number for Baltimore Ketamine Clinic is 1972145381. It was assigned to this organization in the NPPES registry on October 17, 2019.
Where is Baltimore Ketamine Clinic located?
Baltimore Ketamine Clinic is located at 909 Ridgebrook Rd Ste 202, Sparks Glencoe, MD 21152. The listed phone number is (410) 870-5482.
What is Baltimore Ketamine Clinic's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Baltimore Ketamine Clinic enrolled in Medicare?
Yes. Baltimore Ketamine Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Baltimore Ketamine Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Baltimore Ketamine Clinic, in Certified Registered Nurse Anesthetist (CRNA), Nurse Practitioner and Psychiatry. 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. Of these, 1 practice at this address and 2 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 Baltimore Ketamine Clinic was last updated on May 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Baltimore Ketamine Clinic · NPI 1972145381
Psychiatric/Mental Health organization in Sparks Glencoe, Maryland. Organization record, active in the CMS NPPES registry since October 17, 2019.
## Identity
- **NPI:** 1972145381 (Entity type: Organization)
- **Enumerated:** October 17, 2019
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Ivana Mitic, GROUP OWNER
## Practice location
- **Address:** 909 RIDGEBROOK RD STE 202, Sparks Glencoe, MD 21152-9476
- **Phone:** (410) 870-5482 · **Fax:** (410) 628-1212
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Certified Registered Nurse Anesthetist (CRNA) (1), Nurse Practitioner (1), Psychiatry (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 15, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1972145381) · Data from the CMS NPPES public registry.