Individual provider Active NPI

Jennifer Brown, P.A.-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1720099674
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0000223 Issued in DE
Practice address
4745 Ogletown Stanton Rd
Suite 225
Newark, DE 19713-2067
Phone
(302) 731-2888
Fax
(302) 368-0103
NPI assigned
Aug 10, 2006
Last updated
Nov 22, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0000223 DE Primary

Addresses

Primary practice location

4745 Ogletown Stanton Rd
Suite 225
Newark, DE 19713-2067

Mailing address

4745 Ogletown Stanton Rd
Suite 225
Newark, DE 19713-2067
Phone (302) 731-2888

Other identifiers 1

IdentifierTypeStateIssuer
1720099674MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, MD2 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
I20070208000493 DE Practitioner - Physician Assistant 4981606654 Reassigns benefits to 1 organization
I20190226001538 MD Practitioner - Physician Assistant 4981606654 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C5-0000223DEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MNR Industries LLC Current Accepting new patients
MNR Industries, LLC CurrentSince Jan 5, 2019 Accepting new patients
MNR Industries, LLC CurrentSince Jan 5, 2019 Accepting new patients
Atlantic Physician Services of Maryland, PC Physician Assistant Past Accepting new patients
First State Orthopaedics, PA Past Accepting new patients
Christiana Care Quality Partners PastSince Aug 1, 2021 Accepting new patients

Locations

1505 E Churchville Rd
Bel Air, MD 21014
Phone (410) 420-6970

1505 E Churchville Rd
#A
Bel Air, MD 21014
Phone (410) 420-6970

504 E Ridgeville Blvd
#A
Mount Airy, MD 21771
Phone (301) 703-5452

101 North East Plz
North East, MD 21901
Phone (410) 543-2020

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321920000000",
    "number": "1720099674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 OGLETOWN STANTON RD",
            "address_2": "SUITE 225",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132067",
            "telephone_number": "302-731-2888",
            "fax_number": "302-368-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 OGLETOWN STANTON RD",
            "address_2": "SUITE 225",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132067",
            "telephone_number": "302-731-2888",
            "fax_number": "302-368-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JENNIFER",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2011-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0000223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720099674",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.