Individual provider Active NPI

Jennifer Lynn Udan

  • Medical Physician Assistant
  • Baltimore, MD
National Provider Identifier
1811176308
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C0003596 Issued in MD
Practice address
8830 Belair Rd
Surgical PA'S
Baltimore, MD 21236-2401
Phone
(410) 529-9200
Fax
(410) 529-9203
NPI assigned
Oct 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X C0003596 MD Primary

Addresses

Primary practice location

8830 Belair Rd
Surgical PA'S
Baltimore, MD 21236-2401

Mailing address

5000 Cox Rd
Glen Allen, VA 23060-9263
Phone (804) 968-5700

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
I20071231000044 MD Practitioner - Physician Assistant 1759461965 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Practice addresses (Care Compare)

12 Newport Dr
Forest Hill, MD 21050-1758

7505 Osler Dr
Towson, MD 21204-7740

7505 Osler Dr
Suite 305 307
Towson, MD 21204-7736
Phone (410) 337-4877

7601 Osler Dr
Towson, MD 21204-7700
Phone (410) 337-1379

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.09 of 100Reported as group
Quality
79.06
Promoting interoperability
100
Improvement activities
40
Cost
77.9

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland St. Joseph Medical Group, LLC CurrentSince Jul 6, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

900 Elkridge Landing Rd
Fl 2
Linthicum Heights, MD 21090
Phone (443) 462-5010

7601 Osler Dr
Towson, MD 21204
Phone (410) 337-1150

7505 Osler Dr
Ste 500
Towson, MD 21204
Phone (410) 337-4882

Interoperability endpoints

  • Direct secure messaging: judan685642@direct.umm.edu

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1811176308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 COX RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230609263",
            "telephone_number": "804-968-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8830 BELAIR RD",
            "address_2": "SURGICAL PA'S",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212362401",
            "telephone_number": "410-529-9200",
            "fax_number": "410-529-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDAN",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0003596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.