Active NPI
Jill A Pellicoro, MD
- Pediatrics Physician
- Upper Marlboro, MD
National Provider Identifier
1285770214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0055269
- Practice address
- 9692 Pennsylvania Ave
Upper Marlboro, MD 20772-3670 - Phone
- (301) 599-7300
- Fax
- (301) 599-0476
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0055269 | MD | Primary |
| Pediatric Adolescent Medicine Physician | 2080A0000X | D0055269 | MD |
Addresses
Primary practice location
9692 Pennsylvania Ave
Upper Marlboro, MD 20772-3670
Mailing address
9692 Pennsylvania Ave
Upper Marlboro, MD 20772-3670
Phone (301) 599-7300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 407983300 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0055269 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Pediatricians & Associates, LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Silver Spring, MD
- NPI 1396932687
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328572800000",
"number": "1285770214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9692 PENNSYLVANIA AVE",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207723670",
"telephone_number": "301-599-7300",
"fax_number": "301-599-0476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9692 PENNSYLVANIA AVE",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207723670",
"telephone_number": "301-599-7300",
"fax_number": "301-599-0476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLICORO",
"first_name": "JILL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2012-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0055269",
"primary": true
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "MD",
"license": "D0055269",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "407983300",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.