Jennifer Lacey Pantoja, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R218266 Issued in MD

Practice address

61 Thomas Johnson Dr Ste B
Frederick, MD 21702-4301

Phone

(240) 215-0454

NPI assigned

Feb 22, 2016

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

• Jennifer Lacey Hussell Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Frederick Health Hospital Inc

  dba Frederick Health Hospital

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

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1285093047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20805 FAIRWAY VIEW DR",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208821841",
            "telephone_number": "434-610-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 THOMAS JOHNSON DR STE B",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024301",
            "telephone_number": "240-215-0454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTOJA",
        "first_name": "JENNIFER",
        "middle_name": "LACEY",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-22",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R218266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "HUSSELL",
            "middle_name": "LACEY",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pamela Shepp Counseling
• Pratima Pandey, MD
• Bobby Pandiarajan
• Kaley M Paniwozik, MA CCC-SLP
• Denise Ellen Pankow
• Ellen Pape
• Zinon M Pappas, M.D.
• Ngun Hleih Par Thang
• Thomas Rajan Parambil, MD
• Paraview Behavioral Health

• Family Nurse Practitioner in Frederick, MD
• Providers in Frederick, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.