Jacquelyn P Bauer, C.R.N.P.
Individual provider Active NPI Pediatric Nurse Practitioner · Oakland, MD
NPI 1124010004 · NPPES record last updated Dec 17, 2025
Key facts
- NPI
- 1124010004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- R110105 (MD)
- Practice address
- 1027 Memorial Dr
Oakland, MD 21550-4343 - Phone
- (301) 533-3300
- Fax
- (833) 448-0361
- NPI assigned
- Aug 17, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Western Maryland Health Care Corporation
Practice addresses (Care Compare)
1027 Memorial Dr
Oakland, MD 21550-4343
Phone 30153333003081
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WV, MD, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050315000327 | WV | Practitioner - Nurse Practitioner | 7719932524 | Reassigns benefits to 1 organization |
| I20130311000045 | MD | Practitioner - Nurse Practitioner | 7719932524 | Reassigns benefits to 4 organizations |
| I20140507000793 | VA | Practitioner - Nurse Practitioner | 7719932524 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R110105 | MD | MD | Neonatal Nurse Practitioner |
| SP018623 | PA | MD | Pediatric Nurse Practitioner |
Practice roles
Locations
500 Greene St
Cumberland, MD 21502
Phone (301) 724-7616
1 Science Park
Frostburg, MD 21532
Phone (301) 729-2235
104 Parkview Dr
Grantsville, MD 21536
Phone (301) 895-5107
1226 National Hwy
Lavale, MD 21502
Phone (301) 709-0357
1027 Memorial Dr
Oakland, MD 21550
Phone (301) 533-3300
7601 Osler Dr
Towson, MD 21204
Phone (410) 337-1150
22221 Westernport Rd SW
Westernport, MD 21562
Phone (240) 774-0204
1840 Amherst St
Winchester, VA 22601
Phone (540) 536-8700
1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500
Interoperability endpoints
- jacquelyn.bauer.1@28818.direct.athenahealth.com
- jbauer1051703@direct.hopkinsmedicine.org
- jacquelynbauercrnp@childrensm.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal Nurse Practitioner | 363LN0000X | R110105 | MD | |
| Pediatric Nurse Practitioner | 363LP0200X | R110105 | MD | Yes |
| Pediatric Nurse Practitioner | 363LP0200X | SP018623 | PA |
Addresses
Primary practice location
1027 Memorial Dr
Oakland, MD 21550-4343
Mailing address
1027 Memorial Dr
Oakland, MD 21550-4343
Phone (301) 533-3300
Other practice location 1
12500 Willowbrook Rd
Cumberland, MD 21502-6393
Phone (240) 964-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0167161000 | Medicaid | WV | |
| 1124010004 | Medicaid | WV | |
| 103470021 | Medicaid | PA | |
| 126751500 | Medicaid | MD |
Other providers in Oakland, MD
- Christopher Daron Baker
- Jean Christine Baker
- Christin Barnard
- Blythe Rachel Barny
- Kim Nicole Barsella
- Sarah S Beck
- Britni Beitzel
- Randi Nichole Bennett
- Susan Kay Bennett
- Betheny J Benson
All providers in Oakland, MD · Pediatric Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.