Individual provider Active NPI

Mekdelawit Tadesse

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1063249837
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0010028 Issued in MD
Practice address
520 W Fayette St Ste 300
Baltimore, MD 21201-1756
Phone
(240) 350-2854
NPI assigned
Sep 17, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0010028 MD Primary

Addresses

Primary practice location

520 W Fayette St Ste 300
Baltimore, MD 21201-1756

Mailing address

520 W Fayette St Ste 300
Baltimore, MD 21201-1756

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251003002021 DC Practitioner - Physician Assistant 9032615497 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Maryland School of Medicine, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2100 Powell St
Emeryville, CA 94608-1826

Hospital & facility affiliations

  • Holy Cross Hospital Hospital, Silver Spring, MD, CCN 210004
  • Holy Cross Germantown Hospital Hospital, Germantown, MD, CCN 210065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC CurrentSince Sep 18, 2025 Accepting new patients
Cep America, LLC CurrentSince Sep 18, 2025 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2041 Georgia Ave NW
Washington, DC 20060
Phone (202) 865-3785

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1063249837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W FAYETTE ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W FAYETTE ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011756",
            "telephone_number": "240-350-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADESSE",
        "first_name": "MEKDELAWIT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-17",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0010028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.