Individual provider Active NPI

Ameena Jain, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1093064073
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R211311 Issued in MD
Practice address
1012 S North Point Rd
Baltimore, MD 21224-3338
Phone
(443) 216-4800
NPI assigned
Sep 5, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 764950 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R211311 MD Primary

Addresses

Primary practice location

1012 S North Point Rd
Baltimore, MD 21224-3338

Mailing address

1012 S North Point Rd
Baltimore, MD 21224-3338
Phone (443) 216-4800

Other identifiers 1

IdentifierTypeStateIssuer
306307501MedicaidTX

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
I20170426002742 MD Practitioner - Nurse Practitioner 9537318787 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sheppard Pratt Physicians PAGroup PAC ID 8224937610, 70 clinicians

Practice addresses (Care Compare)

6501 N Charles St
Baltimore, MD 21204-6819
Phone (410) 938-5000

7220 Discovery Dr
Elkridge, MD 21075-7414
Phone (410) 938-3000

Hospital & facility affiliations

  • Greater Baltimore Medical Center Hospital, Baltimore, MD, CCN 210044

Merit-based Incentive Payment System (MIPS)

Final score
66.41 of 100Reported as group
Quality
30.12
Promoting interoperability
80
Improvement activities
40
Cost
57.93

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R211311MDMDPsychiatric/Mental Health Nurse Practitioner
764950TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aspire Wellness Center, Inc. CurrentSince Aug 12, 2020 Accepting new patients
Sheppard Pratt Physicians, P.a. CurrentSince Jun 1, 2021 Accepting new patients
Dynamic Wellness Center, LLC CurrentSince Aug 18, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5022 Campbell Blvd
Ste Lm
Nottingham, MD 21236
Phone (443) 442-1568

6501 N Charles St
Towson, MD 21204
Phone (410) 938-3000

210 W Pennsylvania Ave
Ste 100
Towson, MD 21204
Phone (443) 201-1991

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1093064073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 S NORTH POINT RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243338",
            "telephone_number": "443-216-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 S NORTH POINT RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243338",
            "telephone_number": "443-216-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "AMEENA",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "764950",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R211311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306307501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.