Individual provider Active NPI

Jessica Lynn Poretz

  • Family Medicine Physician
  • Severna Park, MD
National Provider Identifier
1043181225
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R241298 Issued in MD
Practice address
815 Ritchie Hwy Ste 120
Severna Park, MD 21146-4192
Phone
(443) 534-4793
NPI assigned
Sep 12, 2025
Last updated
Sep 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R241298 MD Primary

Addresses

Primary practice location

815 Ritchie Hwy Ste 120
Severna Park, MD 21146-4192

Mailing address

713 Tyler Point Rd
Deale, MD 20751-9733
Phone (410) 200-0636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20260108001276 MD Practitioner - Nurse Practitioner 5890271977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrative Family NP LLCGroup PAC ID 8729580840, 2 clinicians

Practice addresses (Care Compare)

815 Ritchie Hwy
Suite 120
Severna Park, MD 21146-4192
Phone (443) 534-4793

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R241298MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Family NP LLC CurrentSince Dec 30, 2025 Accepting new patients

Locations

815 Ritchie Hwy
Ste 120
Severna Park, MD 21146
Phone (443) 534-4793

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1757635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1043181225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 TYLER POINT RD",
            "city": "DEALE",
            "state": "MD",
            "postal_code": "207519733",
            "telephone_number": "410-200-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 RITCHIE HWY STE 120",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211464192",
            "telephone_number": "443-534-4793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORETZ",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "R241298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Severna Park, MD

Sources for this page

Verify at the official NPI Registry.