Individual provider Active NPI

Peyton Marion Cassidy, PA-C

  • Medical Physician Assistant
  • Annapolis, MD
National Provider Identifier
1568230019
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
7028 Clinton CT
Annapolis, MD 21403-7601
Phone
(443) 813-0172
NPI assigned
Dec 14, 2023
Last updated
Dec 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

7028 Clinton CT
Annapolis, MD 21403-7601

Mailing address

7028 Clinton CT
Annapolis, MD 21403-7601
Phone (443) 813-0172

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20241113002936 MD Practitioner - Physician Assistant 1153855135 Reassigns benefits to 1 organization
I20241113003017 DC Practitioner - Physician Assistant 1153855135 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

1106 Annapolis Rd
Suite 130
Odenton, MD 21113-1739
Phone (410) 268-8862

2000 Medical Pkwy
Suite 101
Annapolis, MD 21401-3743
Phone (410) 268-8862

2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone (443) 481-1000

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Oct 1, 2024 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Oct 1, 2024 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Oct 1, 2024 Accepting new patients

Locations

2000 Medical Pkwy
Ste 409
Annapolis, MD 21401
Phone (443) 481-5136

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

4175 N Hanson Ct
Ste 201
Bowie, MD 20716
Phone (443) 481-1199

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1702512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1568230019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7028 CLINTON CT",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214037601",
            "telephone_number": "443-813-0172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7028 CLINTON CT",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214037601",
            "telephone_number": "443-813-0172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASSIDY",
        "first_name": "PEYTON",
        "middle_name": "MARION",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.