Individual provider Active NPI

Jordan Barrett Nalls

  • Surgical Physician Assistant
  • Catonsville, MD
National Provider Identifier
1417892878
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
910 Frederick Rd
Catonsville, MD 21228-4516
Phone
(410) 644-1880
NPI assigned
Apr 22, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

910 Frederick Rd
Catonsville, MD 21228-4516

Mailing address

14530 Dorsey Mill Rd
Glenwood, MD 21738-9320
Phone (240) 394-2580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1776816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1417892878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14530 DORSEY MILL RD",
            "city": "GLENWOOD",
            "state": "MD",
            "postal_code": "217389320",
            "telephone_number": "240-394-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 FREDERICK RD",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212284516",
            "telephone_number": "410-644-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALLS",
        "first_name": "JORDAN",
        "middle_name": "BARRETT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-22",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Catonsville, MD

Sources for this page

Verify at the official NPI Registry.