Individual provider Active NPI

Jennifer Gillman

  • Nuclear Medicine Physician
  • MC Lean, VA
National Provider Identifier
1023405636
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Medicine PhysicianTaxonomy code 207U00000X
License
0101271585 Issued in VA
Practice address
8008 Westpark Dr
MC Lean, VA 22102-3109
Phone
(703) 287-6400
NPI assigned
Apr 21, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X 0101271585 VA Primary

Addresses

Primary practice location

8008 Westpark Dr
MC Lean, VA 22102-3109

Mailing address

8008 Westpark Dr
MC Lean, VA 22102-3109

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, DC, VA, MD4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20210901001934 GA Practitioner - Diagnostic Radiology 3072919919 Reassigns benefits to 1 organization
I20210915000396 DC Practitioner - Diagnostic Radiology 3072919919 Reassigns benefits to 1 organization
I20220912001322 VA Practitioner - Diagnostic Radiology 3072919919 Reassigns benefits to 1 organization
I20230128000294 MD Practitioner - Nuclear MedicinePractitioner - Diagnostic Radiology 3072919919 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
New York University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, shared by 17 NPIs, 1,921 clinicians

Practice addresses (Care Compare)

12201 Plum Orchard Dr
Silver Spring, MD 20904-7803
Phone (301) 572-1000

1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700

1396 Piccard Dr
Rockville, MD 20850-4302
Phone (301) 548-5700

14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Phone (703) 257-3000

1890 Metro Ctr Dr
Reston, VA 20190-5286
Phone (703) 709-1500

201 N Washington St
Falls Church, VA 22046-4518
Phone (703) 237-4000

2391 Greenspring Dr
Timonium, MD 21093-6038
Phone (301) 816-2424

5100 Auth Way
Suitland, MD 20746-4207
Phone (301) 702-5000

6104 Old Branch Ave
Temple Hills, MD 20748-2518
Phone (301) 702-6100

655 Watkins Mill Rd
Gaithersburg, MD 20879-3301
Phone (240) 632-4000

6551 Loisdale CT
Springfield, VA 22150-1828
Phone (703) 922-1000

8008 Westpark Dr
MC Lean, VA 22102-3109
Phone (703) 287-6400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101271585VAMDNuclear Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Jun 1, 2022 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 7, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Oct 19, 2022 Accepting new patients
The Southeast Permanente Medical Group CurrentSince Aug 1, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 7, 2021 Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2400 Mount Zion Pkwy
Jonesboro, GA 30236
Phone (770) 603-3649

7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600

7190 Crestwood Blvd
Frederick, MD 21703
Phone (240) 529-1700

1701 Twin Springs Rd
Halethorpe, MD 21227
Phone (410) 737-5000

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

2391 Greenspring Dr
Timonium, MD 21093
Phone (410) 847-3000

6701 N Charles St
Towson, MD 21204
Phone (443) 849-2000

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

8008 Westpark Dr
Tysons Corner, VA 22102
Phone (703) 287-6400

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1023405636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8008 WESTPARK DR",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8008 WESTPARK DR",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023109",
            "telephone_number": "703-287-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLMAN",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "VA",
            "license": "0101271585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2400 Mount Zion Pkwy",
            "city": "Jonesboro",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302362500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in MC Lean, VA

Sources for this page

Verify at the official NPI Registry.