NPIMap

Individual provider Active NPI

Jennifer Karen Landsman, MD

  • Pediatrics Physician
  • Ellicott City, MD
National Provider Identifier
1073576963
Registry record updated Oct 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0057413 Issued in MD
Practice address
9011 Chevrolet Dr
Suites 1-6
Ellicott City, MD 21043-4024
Phone
(410) 465-7550
Fax
(410) 465-7085
NPI assigned
Apr 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0057413 MD Primary

Addresses

Primary practice location

9011 Chevrolet Dr
Suites 1-6
Ellicott City, MD 21043-4024

Mailing address

9011 Chevrolet Dr
Suites 1-6
Ellicott City, MD 21043-4024
Phone (410) 465-7550

Other identifiers 1

IdentifierTypeStateIssuer
769903400MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0057413MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ellicott City Pediatric Assoc Pediatrics Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Trusted Doctors LLC Pediatrics Past Accepting new patients
Baltimore Washington Emergency Physicians, Inc. Past Accepting new patients

Organizations & group practices 4

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286496000000",
    "number": "1073576963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9011 CHEVROLET DR",
            "address_2": "SUITES 1-6",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434024",
            "telephone_number": "410-465-7550",
            "fax_number": "410-465-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9011 CHEVROLET DR",
            "address_2": "SUITES 1-6",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434024",
            "telephone_number": "410-465-7550",
            "fax_number": "410-465-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDSMAN",
        "first_name": "JENNIFER",
        "middle_name": "KAREN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2010-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0057413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "769903400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.