Individual provider Active NPI

Jason Simon Javillo, M.D.

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1366472557
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0063881 Issued in MD
Practice address
2435 W Belvedere Ave
Suite 22
Baltimore, MD 21215-5224
Phone
(410) 601-6840
Fax
(410) 601-5789
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0063881 MD Primary

Addresses

Primary practice location

2435 W Belvedere Ave
Suite 22
Baltimore, MD 21215-5224

Mailing address

2401 W Belvedere Ave
Attn: Credentialing
Baltimore, MD 21215-5216
Phone (410) 601-5524

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061017000504 MD Practitioner - Internal Medicine 3173529070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Sinai Hospital of Baltimore, IncGroup PAC ID 0941112346, 373 clinicians

Practice addresses (Care Compare)

2435 W Belvedere Ave
22 Sinai General Medicine Associates
Baltimore, MD 21215-5266
Phone (410) 601-6840

Hospital & facility affiliations

  • Homecare Maryland, LLC Home health agency, Owings Mills, MD, CCN 217107
  • Centerwell Home Health Home health agency, Columbia, MD, CCN 217071
  • Sinai Hospital of Baltimore Hospital, Baltimore, MD, CCN 210012
  • Northwest Hospital Center Hospital, Randallstown, MD, CCN 210040

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0063881MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sinai Hospital of Baltimore, Inc. CurrentSince Jul 1, 2006 Accepting new patients
Sinai Hospital of Baltimore Inc Internal Medicine CurrentSince Jul 1, 2006 Accepting new patients
Sinai Hospital of Baltimore Inc Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5101 Lanier Ave
Baltimore, MD 21215
Phone (410) 542-7800

2435 W Belvedere Ave
Ste 56
Baltimore, MD 21215
Phone (410) 578-8632

2435 W Belvedere Ave
Ste 22
Baltimore, MD 21215
Phone (410) 601-6340

2401 W Belvedere Ave
Baltimore, MD 21215

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

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.

Hospital & facility affiliations 5

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192492800000",
    "number": "1366472557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W BELVEDERE AVE",
            "address_2": "ATTN: CREDENTIALING",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155216",
            "telephone_number": "410-601-5524",
            "fax_number": "410-601-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 W BELVEDERE AVE",
            "address_2": "SUITE 22",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155224",
            "telephone_number": "410-601-6840",
            "fax_number": "410-601-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVILLO",
        "first_name": "JASON",
        "middle_name": "SIMON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2007-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0063881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.