Jessica Pryor, PA-C

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C0008195 Issued in MD

Practice address

12150 Annapolis Rd Ste 208
Glenn Dale, MD 20769-9183

Phone

(301) 218-0398

NPI assigned

Oct 8, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpryor1172922@soc.inova.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inova Health Care Services

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1952320061

  DC

  Medicare reassignment
• Inova Health Care Services

  dba Radiology Imaging Associates

  • Diagnostic Radiology Physician
  • Waldorf, MD
  • NPI 1851829550
  NPD
• Inova Health Care Services

  dba Inova Blood Donor Services

  • Medical Technologist
  • Sterling, VA
  • NPI 1699655589
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1003578899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 CONNECTICUT AVE NW APT 402",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200085301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS RD STE 208",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699183",
            "telephone_number": "301-218-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRYOR",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "C0008195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Privia Medical Group, LLC
• Privia Medical Group, LLC
• Proactive Healthcare Services LLC
• Proactive Healthcare Services LLC
• Glenda Prudencio, PA-C
• Quantum Rehabilitation Medicine
• Ketki Ajit Raktavan, MPT
• Donald Reese
• Rehabit Smartcenter, LLC
• Remediez LLC

• Pediatrics Physician in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.