Jeuelle M Ottley Sam, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0002743 Issued in MD

Practice address

7610 Carroll Ave
Suite 200
Takoma Park, MD 20912-6384

Phone

(301) 891-2077

Fax

(301) 891-2080

NPI assigned

Dec 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, FL, CA, NJ, GA5 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 5

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thriving LaneGroup PAC ID 1355741083, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: thrivinglanellc.jeuellemelodyottleysam@149897.advancedmd-direct.com

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.

• Thriving Lane

  • Psychiatry Physician
  • Naples, FL
  • NPI 1376122515

  CA, GA, MD, NJ

  Medicare reassignment Care Compare group
• Mind & Soul Telewellness LLC

  • Mental Health Counselor
  • Towson, MD
  • NPI 1205495496
  Medicare reassignment

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1740341924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 PARK CENTER CT",
            "address_2": "STE 210",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175604",
            "telephone_number": "443-953-8922",
            "fax_number": "855-955-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7610 CARROLL AVE",
            "address_2": "SUITE 200",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209126384",
            "telephone_number": "301-891-2077",
            "fax_number": "301-891-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTLEY SAM",
        "first_name": "JEUELLE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0002743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lovinna Onyejiaka, DNP,MSN, FNP-BC
• Onyinye Rosemary Onyemenam
• Nisha Orren, PA-C
• Edith Osei, CRNP
• Nurat Oshinaike
• Fatouma Ouattara
• Nelle Hannah Ouellette, OTR/L, CBIS
• Elham Oumer, PA-C
• Pablo Renart MD
• Yancy Evelyn Padilla, LSWA

• Physician Assistant in Takoma Park, MD
• Providers in Takoma Park, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; 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.