Individual provider Active NPI

Jennifer Wylie Watts, M.S, PA-C

  • Physician Assistant
  • Aberdeen, MD
National Provider Identifier
1215245485
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0004361 Issued in MD
Practice address
995 Hospitality Way
Aberdeen, MD 21001-1755
Phone
(410) 306-7880
Fax
(410) 306-7881
NPI assigned
Sep 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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 C0004361 MD Primary

Addresses

Primary practice location

995 Hospitality Way
Aberdeen, MD 21001-1755

Mailing address

5000 Cox Rd
Glen Allen, VA 23060-9263
Phone (804) 968-5700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MDExchange@patientfirstclinics.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110307000902 MD Practitioner - Physician Assistant 2062694409 Reassigns benefits to 1 organization
I20161129000393 DC Practitioner - Physician Assistant 2062694409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Patient First Maryland Medical Group PLLCGroup PAC ID 4385538735, shared by 26 NPIs, 258 clinicians

Practice addresses (Care Compare)

10210 Reisterstown Rd
Owings Mills, MD 21117-3606
Phone (410) 902-6776

10424 Baltimore Ave
Beltsville, MD 20705-2321
Phone (240) 542-5987

10755 Falls Rd
Suite 160
Lutherville, MD 21093-4588
Phone (410) 583-2777

4924 Campbell Blvd
Suite 125
Baltimore, MD 21236-5921
Phone (443) 461-1997

5100 Eastern Ave
Bayview
Baltimore, MD 21224-2772
Phone (410) 814-4500

560 W Macphail Rd
Bel Air, MD 21014-4320
Phone (410) 638-6480

5900 Cedar LN
Columbia, MD 21044-3635
Phone (443) 718-4067

6201 Annapolis Rd
Landover Hills, MD 20784-1307
Phone (301) 276-3377

7116 Ritchie Hwy
Glen Burnie, MD 21061-2904
Phone (443) 577-0277

726 Rockville Pike
Rockville, MD 20852-1133
Phone (240) 238-0411

8105 Ritchie Hwy
Pasadena, MD 21122-3905
Phone (443) 573-0564

8830 Belair Rd
Baltimore, MD 21236-2401
Phone (410) 529-9200

950 York Rd
Towson, MD 21204-2513
Phone (410) 372-6373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0004361MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Patient First Maryland Medical Group, PLLC CurrentSince Jul 28, 2016 Accepting new patients
Patient First Maryland Medical Group PLLC CurrentSince Jul 28, 2016 Accepting new patients
Patient First Maryland Medical Group PLLC CurrentSince Oct 1, 2016 Accepting new patients
Medlantic Healthcare Group Past Accepting new patients

Locations

995 Hospitality Way
Aberdeen, MD 21001
Phone (410) 306-7880

10210 Reisterstown Rd
#12302
Owings Mills, MD 21117
Phone (410) 902-6776

10210 Reisterstown Rd
Owings Mills, MD 21117
Phone (410) 902-6776

726 Rockville Pike
Rockville, MD 20852
Phone (240) 238-0411

2855 Crain Hwy
Waldorf, MD 20601
Phone (240) 427-1926

5000 Cox Rd
Glen Allen, VA 23060
Phone (804) 822-4355

Interoperability endpoints

  • Direct secure messaging: mdexchange@patientfirstclinics.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1215245485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 COX RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230609263",
            "telephone_number": "804-968-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 HOSPITALITY WAY",
            "city": "ABERDEEN",
            "state": "MD",
            "postal_code": "210011755",
            "telephone_number": "410-306-7880",
            "fax_number": "410-306-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "JENNIFER",
        "middle_name": "WYLIE",
        "credential": "M.S, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-21",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0004361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MDExchange@patientfirstclinics.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "995 Hospitality Way",
            "city": "Aberdeen",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210011755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aberdeen, MD

Sources for this page

Verify at the official NPI Registry.