Amanda Mary Jackiewicz, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0006512 Issued in MD

Practice address

Greater Maryland Pain Management
1130 Annapolis Rd Suite 100
Odenton, MD 21113

Phone

(410) 672-2255

NPI assigned

Jul 10, 2017

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Paul Place Specialists, Inc.Group PAC ID 7719882943, 332 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Center Inc Hospital, Baltimore, MD, CCN 210008

Merit-based Incentive Payment System (MIPS)

Final score

79.13 of 100Reported as group

Quality

56.5

Promoting interoperability

100

Improvement activities

40

Cost

73.94

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajackiewicz86177@direct.mdmercy.com

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. Paul Place Specialists, Inc.

  • Orthopaedic Foot and Ankle Surgery Physician
  • Baltimore, MD
  • NPI 1871549196
  Medicare reassignment Care Compare group
• Greater Maryland Pain Management, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Odenton, MD
  • NPI 1710312723
  Medicare reassignment NPD
• Lifebridge Orthopedic Specialists, LLC

  • Neurological Surgery Physician
  • Baltimore, MD
  • NPI 1841696697
  Medicare reassignment
• Maryland Spine Center Chartered

  • Orthopaedic Surgery of the Spine Physician
  • Baltimore, MD
  • NPI 1952418535
  Medicare reassignment
• Greater Maryland Pain Management, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Annapolis, MD
  • NPI 1346135902
  NPD
• St Paul Place Specialists Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1497707681
  NPD
• St Paul Place Specialists, Inc.

  • Orthopaedic Surgery Physician
  • Baltimore, MD
  • NPI 1851405187

  Physician Assistant

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Medical Center Inc

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1144282583
  Care Compare affiliation

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1730601949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 SILVER KNOLL DR",
            "city": "PERRY HALL",
            "state": "MD",
            "postal_code": "211289165",
            "telephone_number": "410-299-4359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GREATER MARYLAND PAIN MANAGEMENT",
            "address_2": "1130 ANNAPOLIS RD SUITE 100",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "21113",
            "telephone_number": "410-672-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 W Belvedere Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212155216",
            "country_code": "US",
            "telephone_number": "410-601-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKIEWICZ",
        "first_name": "AMANDA",
        "middle_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-10",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C06512",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0006512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; 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.