Jack W McWatters, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

D27237 Issued in MD

Practice address

11085 Little Patuxent Pkwy
Suite 101
Columbia, MD 21044-2983

Phone

(410) 997-7979

Fax

(410) 997-9231

NPI assigned

Mar 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Dedicated Imaging of Baltimore

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1487654398
  NPD (past)

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232582400000",
    "number": "1083681118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11085 LITTLE PATUXENT PKWY",
            "address_2": "SUITE 101",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442983",
            "telephone_number": "410-997-7979",
            "fax_number": "410-997-9231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11085 LITTLE PATUXENT PKWY",
            "address_2": "SUITE 101",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442983",
            "telephone_number": "410-997-7979",
            "fax_number": "410-997-9231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCWATTERS",
        "first_name": "JACK",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2009-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "D27237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS PPO,SPP,BC",
            "identifier": "0005",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "04071",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC",
            "identifier": "21750",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403161000",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHCARE HMO",
            "identifier": "0481422",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2500675",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI CARDIOLOGY",
            "identifier": "225079",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS MD",
            "identifier": "35016302",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHCARE NON-HMO",
            "identifier": "4105495",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Anderson McNear
• Verritta McNeely, RN
• Quinton McNeil
• Au'Bryone Dynelle McQueen
• Renee McSwain
• Douglas McWilliams, MD
• MD Laser Medicine and Surgery Inc
• MD Laser Surgery Center, LLC
• MD Oms SDS, LLC
• MD Pain Relief Center, LLC

• Specialist in Columbia, MD
• Providers in Columbia, MD by specialty
• Specialist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; 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.