Individual provider Active NPI

Janina Bukowski, PA-C

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1750305397
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0005354 Issued in MD
Practice address
711 W 40TH St Ste 206
Baltimore, MD 21211-2108
Phone
(410) 842-6055
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X C0005354 MD
Physician Assistant 363A00000X C0005354 MD Primary

Addresses

Primary practice location

711 W 40TH St Ste 206
Baltimore, MD 21211-2108

Mailing address

711 West 40TH St
Suite 206
Baltimore, MD 21211
Phone (410) 949-5533

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170131000146 MD Practitioner - Physician Assistant 0446266639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
B'More Mental Health and Wellness, LLCGroup PAC ID 0143666073, 3 clinicians

Practice addresses (Care Compare)

711 W 40TH St
Baltimore, MD 21211-2108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
900MAMDMarriage & Family Therapist
C0005354MDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
B'More Mental Health and Wellness, LLC Physician Assistant CurrentSince Jun 23, 2025 Accepting new patients
The Commonwealth of Massachusetts Past Accepting new patients
The Commonwealth of Massachusetts Past Accepting new patients

Locations

711 W 40th St
Ste 206
Baltimore, MD 21211
Phone (410) 842-6055

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1750305397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 WEST 40TH ST",
            "address_2": "SUITE 206",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21211",
            "telephone_number": "410-949-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W 40TH ST STE 206",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212112108",
            "telephone_number": "410-842-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUKOWSKI",
        "first_name": "JANINA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2025-03-04",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "C0005354",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.