Jennifer M Pederson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C07166 Issued in MD

Practice address

2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746

Phone

(410) 377-8900

Fax

(410) 377-0576

NPI assigned

Dec 17, 2018

Last updated

Jun 14, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centers for Advanced Orthopaedics LLCGroup PAC ID 8123260981, 599 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: 38jpederson@cfaortho.emadirect.md

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.

• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Olney, MD
  • NPI 1487093167
  Medicare reassignment Care Compare group
• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Frederick, MD
  • NPI 1962841627
  NPD
• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Gainesville, VA
  • NPI 1063393833
  NPD
• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Baltimore, MD
  • NPI 1437504875
  NPD (past)
• Orthopaedic Associates of Central Maryland, PA

  • Orthopaedic Surgery Physician
  • Columbia, MD
  • NPI 1023269396
  NPD (past)

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592092800000",
    "number": "1487125340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 LOUIS PL",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522451582",
            "telephone_number": "319-939-7731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DR STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093746",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-0576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1312 Bellona Ave Ste 302",
            "address_purpose": "LOCATION",
            "city": "Lutherville",
            "state": "MD",
            "postal_code": "210935436",
            "country_code": "US",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-0576",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4 Park Center Ct Ste 102",
            "address_purpose": "LOCATION",
            "city": "Owings Mills",
            "state": "MD",
            "postal_code": "211175613",
            "country_code": "US",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-0576",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2020-06-14",
        "certification_date": "2020-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C07166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer.pederson.1@9012.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "2700 Quarry Lake Dr Ste 300",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212093746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lydia Pecker, MD
• Oluwamayomide Akwele Pecku
• Dawn R Pecora, PA-C
• Heather Straka Pecoraro
• Philip Angelo Pecoraro, LCSW-C, DCSW
• Pediatric Partners LLC
• Pediatric Services of America, LLC (Aveanna Healthcare)
• Pediatrix Medical Group of the Mid-Atlantic PC
• Pediatrix of Maryland PA
• Pedirite Medical MD LLC

• Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.