Individual provider Active NPI

Thomas J. Pasquarello, PA-C

  • Physician Assistant
  • Hagerstown, MD
National Provider Identifier
1083609465
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C02125 Issued in MD
Practice address
17 Western Maryland Pkwy
Suite 100
Hagerstown, MD 21740-5471
Phone
(301) 797-9240
Fax
(301) 797-4234
NPI assigned
Sep 13, 2005
Last updated
May 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA001514L PA
Physician Assistant 363A00000X C02125 MD Primary
Medical Physician Assistant 363AM0700X MA001514L PA

Addresses

Primary practice location

17 Western Maryland Pkwy
Suite 100
Hagerstown, MD 21740-5471

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (301) 797-9240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070724000277 PA Practitioner - Physician Assistant 0345341145 Reassigns benefits to 1 organization
I20070815000116 MD Practitioner - Physician Assistant 0345341145

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA001514LPAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince May 5, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

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, 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": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1083609465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "301-797-9240",
            "fax_number": "301-797-4234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WESTERN MARYLAND PKWY",
            "address_2": "SUITE 100",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405471",
            "telephone_number": "301-797-9240",
            "fax_number": "301-797-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASQUARELLO",
        "first_name": "THOMAS",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA001514L",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C02125",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA001514L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.