Active NPI
Jeffrey Peter Indrisano, M.D.
- Geriatric Medicine (Internal Medicine) Physician
- Bethesda, MD
National Provider Identifier
1477599843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- D0037975
- Practice address
- 6410 Rockledge Dr
Suite 401
Bethesda, MD 20817-1809 - Phone
- (301) 890-5001
- Fax
- (301) 890-5193
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | D0037975 | MD | Primary |
Addresses
Primary practice location
6410 Rockledge Dr
Suite 401
Bethesda, MD 20817-1809
Mailing address
9600 Pulaski Park Dr
103
Baltimore, MD 21220-1400
Phone (443) 725-8762
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D0037975 | Other | MD | STATE LICENSE NUMBER |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0037975 | MD | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1477599843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9600 PULASKI PARK DR",
"address_2": "103",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212201400",
"telephone_number": "443-725-8762",
"fax_number": "410-780-8790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6410 ROCKLEDGE DR",
"address_2": "SUITE 401",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208171809",
"telephone_number": "301-890-5001",
"fax_number": "301-890-5193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDRISANO",
"first_name": "JEFFREY",
"middle_name": "PETER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MD",
"license": "D0037975",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "D0037975",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.