NPIMap

Individual provider Active NPI

Jessica D Faidley

  • Medical Physician Assistant
  • Hagerstown, MD
National Provider Identifier
1902234214
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C0005202 Issued in MD
Practice address
11110 Medical Campus Rd
Suite 151
Hagerstown, MD 21742-6700
Phone
(301) 797-7600
Fax
(301) 797-1249
NPI assigned
Oct 23, 2013
Last updated
Nov 18, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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 C0005202 MD Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 151
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Road
Suite 151
Hagerstown, MD 21742
Phone (301) 797-7600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140329000109 MD Practitioner - Physician Assistant 2365673613 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tom Ghobrial MD LLCGroup PAC ID 8325126162, 2 clinicians
Medical Rehabilitation Systems LLCGroup PAC ID 4486547163, 71 clinicians

Practice addresses (Care Compare)

12252 Williams Rd SE
Cumberland, MD 21502-7960

12580 National Pike
Grantsville, MD 21536-3310
Phone (301) 895-5793

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.17 of 100Reported as group
Quality
94.8
Improvement activities
40
Cost
74.17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0005202MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1382486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1902234214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS ROAD",
            "address_2": "SUITE 151",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "21742",
            "telephone_number": "301-797-7600",
            "fax_number": "301-797-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 151",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-797-7600",
            "fax_number": "301-797-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIDLEY",
        "first_name": "JESSICA",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-23",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0005202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.