Individual provider Active NPI

Isabelle Victoria Staab, PA-C

  • Physician Assistant
  • Pasadena, MD
National Provider Identifier
1902475544
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0007996 Issued in MD
Practice address
8105 Ritchie Hwy
Pasadena, MD 21122-3905
Phone
(443) 573-0564
NPI assigned
Jun 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0007996 MD Primary

Addresses

Primary practice location

8105 Ritchie Hwy
Pasadena, MD 21122-3905

Mailing address

5000 Cox Rd
Glen Allen, VA 23060-9263

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address istaab@centennialmedical.com Centennial Medical Group, PA
Direct Messaging Address MDExchange@patientfirstclinics.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210920003616 MD Practitioner - Physician Assistant 1759788680 Reassigns benefits to 1 organization
I20210920003647 DC Practitioner - Physician Assistant 1759788680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10210 Reisterstown Rd
Owings Mills, MD 21117-3606
Phone (410) 902-6776

4924 Campbell Blvd
Suite 125
Baltimore, MD 21236-5921
Phone (443) 461-1997

5900 Cedar LN
Columbia, MD 21044-3635
Phone (443) 718-4067

7116 Ritchie Hwy
Glen Burnie, MD 21061-2904
Phone (443) 577-0277

8105 Ritchie Hwy
Pasadena, MD 21122-3905
Phone (443) 573-0564

950 York Rd
Towson, MD 21204-2513
Phone (410) 372-6373

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0007996MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Patient First Maryland Medical Group PLLC CurrentSince Sep 7, 2021 Accepting new patients
Patient First Maryland Medical Group PLLC CurrentSince Sep 7, 2021 Accepting new patients
Patient First Maryland Medical Group, PLLC Current Accepting new patients
Patient First Maryland Medical Group PLLC CurrentSince Sep 7, 2021 Accepting new patients

Locations

7116 Ritchie Hwy
Glen Burnie, MD 21061
Phone (443) 577-0277

10210 Reisterstown Rd
Owings Mills, MD 21117
Phone (410) 902-6776

10210 Reisterstown Rd
#12302
Owings Mills, MD 21117
Phone (410) 902-6776

8105 Ritchie Hwy
Pasadena, MD 21122
Phone (443) 573-0564

726 Rockville Pike
Rockville, MD 20852
Phone (240) 238-0411

2855 Crain Hwy
Waldorf, MD 20601
Phone (240) 427-1926

5000 Cox Rd
Glen Allen, VA 23060
Phone (804) 822-4355

Interoperability endpoints

  • Direct secure messaging: mdexchange@patientfirstclinics.com

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": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1902475544",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8105 RITCHIE HWY",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211223905",
            "telephone_number": "443-573-0564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAAB",
        "first_name": "ISABELLE",
        "middle_name": "VICTORIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-18",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0007996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "istaab@centennialmedical.com",
            "affiliation": "Y",
            "endpointDescription": "email",
            "affiliationName": "Centennial Medical Group, PA",
            "address_1": "10981 Johns Hopkins Rd",
            "city": "Laurel",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207236002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MDExchange@patientfirstclinics.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "7116 Ritchie Hwy",
            "city": "Glen Burnie",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210612904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pasadena, MD

Sources for this page

Verify at the official NPI Registry.