Individual provider Active NPI

Emmy L Estrada, PA-C

  • Medical Physician Assistant
  • Glenn Dale, MD
National Provider Identifier
1962971309
Registry record updated Nov 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C07063 Issued in MD
Practice address
12150 Annapolis Rd Ste 208
Glenn Dale, MD 20769-9183
Phone
(301) 218-0398
NPI assigned
Nov 14, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 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 C07063 MD Primary

Addresses

Primary practice location

12150 Annapolis Rd Ste 208
Glenn Dale, MD 20769-9183

Mailing address

5709 Stillwell Rd
Rockville, MD 20851-1933
Phone (240) 506-9003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MD2 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
I20201016001697 NY Practitioner - Physician Assistant 2163856394
I20240215004447 MD Practitioner - Physician Assistant 2163856394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Maryland Physicians PAGroup PAC ID 2769394808, 395 clinicians

Practice addresses (Care Compare)

22 S Green St
Baltimore, MD 21201-1544

22 S Greene Stre
Med Ctr GCRC Office
Baltimore, MD 21201-1544
Phone (410) 328-7877

Hospital & facility affiliations

  • University of Maryland Medical Center Hospital, Baltimore, MD, CCN 210002

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C07063MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Physicians, P.a. CurrentSince Jan 6, 2024 Accepting new patients
University of Maryland Physicians P.a. CurrentSince Jan 6, 2024 Accepting new patients

Locations

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

Interoperability endpoints

  • Direct secure messaging: eestrada476127@direct.umm.edu

Organizations & group practices 3

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 1

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": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1962971309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5709 STILLWELL RD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208511933",
            "telephone_number": "240-506-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS RD STE 208",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699183",
            "telephone_number": "301-218-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTRADA",
        "first_name": "EMMY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C07063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenn Dale, MD

Sources for this page

Verify at the official NPI Registry.