NPIMap

Organization Active NPI

Jad Wound Care, LLC

  • Adult Health Nurse Practitioner
  • Columbia, MD
National Provider Identifier
1891440566
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
JAD WOUND CARE, LLC
Practice address
10463 Owen Brown Rd
Columbia, MD 21044-3835
Phone
(301) 660-5654
NPI assigned
Feb 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Authorized official

Name
Adama Panda, CRNPNPI 1437503943
Title
Owner
Phone
(240) 533-1395

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X
Ostomy Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WX1500X
Adult Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

10463 Owen Brown Rd
Columbia, MD 21044-3835

Mailing address

10320 Wilde Lake Ter
Columbia, MD 21044-2529

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230317000819 MD Part B Supplier - Clinic/Group Practice 7719351501 Receives reassigned benefits from 5 practitioners
Practice locations: Columbia, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1891440566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10320 WILDE LAKE TER",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10463 OWEN BROWN RD",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443835",
            "telephone_number": "301-660-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAD WOUND CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "PANDA",
        "authorized_official_first_name": "ADAMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-533-1395",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WX1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Ostomy Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.