NPIMap

Individual provider Active NPI

Jessica Palumbo Peretin, M.D.

  • Anesthesiology Physician
  • Hagerstown, MD
National Provider Identifier
1245261569
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD448290 Issued in PA
Practice address
11110 Medical Campus Rd
Suite 248
Hagerstown, MD 21742-6700
Phone
(240) 313-9800
NPI assigned
Jul 5, 2006
Last updated
Apr 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 21492 WV
Anesthesiology Physician 207L00000X MD448290 PA Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 248
Hagerstown, MD 21742-6700

Mailing address

10203 Saddlebrooke LN
Hagerstown, MD 21740-1578
Phone (304) 886-8998

Other identifiers 1

IdentifierTypeStateIssuer
1804751000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20130916000054 PA Practitioner - Anesthesiology 4981695038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Temple University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

532 W Pittsburgh St
Excela Health Hospitalists
Greensburg, PA 15601-2282
Phone (724) 850-6957

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21492WVMDSpecialist
MD448290PAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Excela Health Physician Practices, Inc. CurrentSince Sep 1, 2016 Accepting new patients
East Pittsburgh Anesthesia LLC Anesthesiology CurrentSince Jan 1, 2023 Accepting new patients
Excela Health Physician Practices, Inc. CurrentSince Sep 1, 2016 Accepting new patients
Excela Health Physician Practices, Inc Current Accepting new patients
Fast Track Anesthesia Specialist PastSince Jan 7, 2004 Accepting new patients
Blue Ridge Anesthesia Associates LLC Anesthesiology Past Accepting new patients
Lifelinc Anesthesia, PLLC Anesthesiology Past Accepting new patients

Locations

463 Brush Run Rd
Greensburg, PA 15601
Phone (724) 691-0354

463 Brush Run Rd
#100
Greensburg, PA 15601
Phone (724) 691-0354

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

Organizations & group practices 7

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 9

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1245261569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10203 SADDLEBROOKE LN",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217401578",
            "telephone_number": "304-886-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 248",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "240-313-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERETIN",
        "first_name": "JESSICA",
        "middle_name": "PALUMBO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WV",
            "license": "21492",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD448290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1804751000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.