Theresa L Dematteo Pugh, MS CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R076644 Issued in MD

Practice address

4924 Campbell Blvd
Suite 200
Nottingham, MD 21236-5908

Phone

(443) 442-2300

Fax

(443) 442-2360

NPI assigned

Sep 22, 2006

Last updated

May 9, 2013By the provider in NPPES

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

Other identifiers 1

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

Nurse Practitioner

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Johns Hopkins Community Physicians, IncGroup PAC ID 8325943707, 764 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: tdematteopugh6788@direct.hopkinsmedicine.org

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.

• Johns Hopkins Community Physicians, Inc

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1578598868
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368057600000",
    "number": "1841390713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 WYMAN PARK DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212112803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4924 CAMPBELL BLVD",
            "address_2": "SUITE 200",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212365908",
            "telephone_number": "443-442-2300",
            "fax_number": "443-442-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTEO PUGH",
        "first_name": "THERESA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MS CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2013-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R076644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "622361300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Decker, COMS
• Kristen Shaw Deitchman, D.O.
• Judith Rubin Dejarnette, MD
• Fernando Alfonso Delgado, MD
• Abigail Demastus
• Kinjal Desai
• Destiny L&M Care Services
• Brandon Detwiler, PHARMD
• Devoted Healthcare Services
• Heather Renee Dewey, LCSW-C

• Pediatric Nurse Practitioner in Nottingham, MD
• Providers in Nottingham, MD by specialty
• Pediatric Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2013; 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.