NPIMap

Individual provider Active NPI

Fallon Renee Bauer, PA-C

  • Physician Assistant
  • Easton, MD
National Provider Identifier
1114279049
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0004883 Issued in MD
Practice address
490 Cadmus LN Ste 102
Easton, MD 21601
Phone
(410) 770-5250
NPI assigned
Oct 2, 2012
Last updated
Aug 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0004883 MD Primary

Addresses

Primary practice location

490 Cadmus LN Ste 102
Easton, MD 21601

Mailing address

900 Elkridge Landing Rd FL 2
Linthicum, MD 21090-2924
Phone (443) 462-5010

Other practice location 1

219 S Washington St
Easton, MD 21601-2913
Phone (410) 822-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121204000025 MD Practitioner - Physician Assistant 5193977809 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

219 S Washington St
Easton, MD 21601-2913
Phone 41082210005845

2540 Centreville Rd
Centreville, MD 21617-2681
Phone (410) 822-1000

490 Cadmus LN
Easton, MD 21601-4091
Phone (410) 822-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0004883MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Community Medical Group, Inc. CurrentSince Apr 27, 2020 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Apr 27, 2020 Accepting new patients

Locations

2540 Centreville Rd
Centreville, MD 21617
Phone (410) 758-4432

219 S Washington St
Easton, MD 21601

490 Cadmus Ln
Ste 102
Easton, MD 21601
Phone (410) 770-5250

509 Idlewild Ave
Easton, MD 21601
Phone (410) 820-6411

900 Elkridge Landing Rd
Fl 2
Linthicum Heights, MD 21090
Phone (443) 462-5010

Interoperability endpoints

  • Direct secure messaging: fbauer483472@direct.umm.edu

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.

Hospital & facility affiliations 8

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": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1114279049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ELKRIDGE LANDING RD FL 2",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210902924",
            "telephone_number": "443-462-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 CADMUS LN STE 102",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "21601",
            "telephone_number": "410-770-5250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "219 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Easton",
            "state": "MD",
            "postal_code": "216012913",
            "country_code": "US",
            "telephone_number": "410-822-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUER",
        "first_name": "FALLON",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0004883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, MD

Sources for this page

Verify at the official NPI Registry.