Garry Carroll Jelen, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110004520 Issued in VA

Practice address

45155 Research PL
Suite 140
Ashburn, VA 20147-4191

Phone

(703) 858-0500

Fax

(703) 858-5155

NPI assigned

Feb 2, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Pure Dermatology and Cosmetic Center LLC

  • Dermatology Physician
  • Chevy Chase, MD
  • NPI 1740883354

  DC

  Medicare reassignment
• Maragh Dermatology, PLLC

  • Dermatology Physician
  • Ashburn, VA
  • NPI 1700073269
  NPD (past)

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1619249950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45155 RESEARCH PL",
            "address_2": "SUITE 140",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474191",
            "telephone_number": "703-858-0500",
            "fax_number": "703-858-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45155 RESEARCH PL",
            "address_2": "SUITE 140",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474191",
            "telephone_number": "703-858-0500",
            "fax_number": "703-858-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELEN",
        "first_name": "GARRY",
        "middle_name": "CARROLL",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004520",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C05299",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jawad H Khan MD SC
• JC Wadhwa PC
• Amanda Jean Baptiste, BCBA
• Ponni Jeevan, LMT
• Heather Jefferson
• Jennifer Lynne Jenks, CPNP
• Albert Jerome, PH.D.
• Joseph Jervey
• Sujin Jeung
• Daphne Anne Jeweler

• Physician Assistant in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.