Rebecca Jane Nicely, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

C06056 Issued in MD

Practice address

900 S Caton Ave
Baltimore, MD 21229-5201

Phone

(667) 234-2414

NPI assigned

Apr 8, 2016

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 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• St Agnes Healthcare Inc

  dba Integrated Specialists Group

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1144250176
  Medicare reassignment NPD
• Greater Baltimore Medical Center, Inc

  dba GBMC Dept of OBGYN, L&D

  • Obstetrics & Gynecology Physician
  • Baltimore, MD
  • NPI 1891855763
  Medicare reassignment
• St Agnes Healthcare Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1780615922
  NPD
• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD (past)

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

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461283200000",
    "number": "1699139303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S CATON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295201",
            "telephone_number": "667-234-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S CATON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295201",
            "telephone_number": "667-234-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICELY",
        "first_name": "REBECCA",
        "middle_name": "JANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-08",
        "last_updated": "2016-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C06056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sahar Niazi, MD
• Suzanne Marie Nibeck, AU.D.
• Emily Nicaise
• Wyatt Nice, MD
• Amy Nicely
• Nicholas J Molinaro DDS PA
• Nicholas R Garcia Family Dentistry PC
• May Nicholas-Holmes, DDS ORTHODONTIST
• Angela Nicholas
• Catherine Nicholas, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; 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.