Individual provider Active NPI

Rebecca Bowser, PAC

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1336710383
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0008022 Issued in MD
Practice address
2200 Kernan Dr
Baltimore, MD 21207-6665
Phone
(410) 448-2500
NPI assigned
Jul 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 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 C0008022 MD Primary

Addresses

Primary practice location

2200 Kernan Dr
Baltimore, MD 21207-6665

Mailing address

1216 Chesapeake Dr
Churchton, MD 20733-9775
Phone (301) 233-1734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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 1

Enrollment IDStateProvider typePAC IDDetails
I20221104000646 MD Practitioner - Physician Assistant 2062889090 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0008022MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Agnes Healthcare Inc CurrentSince Dec 1, 2022 Accepting new patients
St Agnes Healthcare Inc Physician Assistant CurrentSince Dec 1, 2022 Accepting new patients

Locations

900 S Caton Ave
Baltimore, MD 21229
Phone (410) 368-3120

Organizations & group practices 3

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": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1336710383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 CHESAPEAKE DR",
            "city": "CHURCHTON",
            "state": "MD",
            "postal_code": "207339775",
            "telephone_number": "301-233-1734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 KERNAN DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212076665",
            "telephone_number": "410-448-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWSER",
        "first_name": "REBECCA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0008022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.