Marielle Destefano, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4940 Eastern Ave
Baltimore, MD 21224-2735

Phone

(410) 550-0100

Fax

(410) 550-2899

NPI assigned

Sep 4, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Marielle Gibbons Former name

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Upper Chesapeake Orthopedics, LLCGroup PAC ID 4880879162, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umd Upper Chesapeake Medical Center Hospital, Bel Air, MD, CCN 210049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdestefano651583@direct.umm.edu

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.

• Upper Chesapeake Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Bel Air, MD
  • NPI 1942507629
  Medicare reassignment Care Compare group
• Johns Hopkins University

  • Pain Medicine (Anesthesiology) Physician
  • Baltimore, MD
  • NPI 1922008549
  Medicare reassignment
• Agape Physical Therapy & Sports Rehabilitation LP

  • Physical Therapist
  • Forest Hill, MD
  • NPI 1578900668
  Care Compare group
• Johns Hopkins University

  • Orthopaedic Surgery Physician
  • Baltimore, MD
  • NPI 1013913789
  NPD
• Johns Hopkins University

  • Ophthalmology Physician
  • Belcamp, MD
  • NPI 1376342774
  NPD
• Upper Chesapeake Orthopedics, LLC

  • Durable Medical Equipment & Medical Supplies
  • Aberdeen, MD
  • NPI 1679443964
  NPD
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• Upper Chesapeake Medical Center, Inc.

  • General Acute Care Hospital
  • Bel Air, MD
  • NPI 1598761355
  Care Compare affiliation

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557360000000",
    "number": "1104251685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9910 FRANKLIN SQUARE DR STE 2110",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212364902",
            "telephone_number": "410-933-6423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242735",
            "telephone_number": "410-550-0100",
            "fax_number": "410-550-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "MARIELLE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2019-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIELLE",
            "last_name": "GIBBONS",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lynn Desrosiers, FNP-C
• Lulit Negash Dessie, MD
• Sandy Dessources
• Kalkidan Desta
• Erica Debra Destefano
• Kisha Destin, MD
• Judy M Destouet, MD
• Barbara Detrick, PHD
• Jessica Detrick
• Stephanie Detterline, MD

• Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.