Active NPI
Jessica Derreth
- Physician Assistant
- Baltimore, MD
National Provider Identifier
1972060044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C06975
- Practice address
- 601 N Caroline St
Baltimore, MD 21287-0006 - Phone
- (443) 997-9466
- NPI assigned
- Feb 26, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C06975 | MD | Primary |
Addresses
Primary practice location
601 N Caroline St
Baltimore, MD 21287-0006
Mailing address
5100 Whiteford Ave
Baltimore, MD 21212-4108
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190604002229 | MD | Order and Referring Only - Physician Assistant | 8527391606 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C06975 | MD | MD | Physician Assistant |
Interoperability endpoints
- jderreth519982@direct.hopkinsmedicine.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1972060044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 WHITEFORD AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212124108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 N CAROLINE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212870006",
"telephone_number": "443-997-9466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRETH",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-26",
"last_updated": "2019-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C06975",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.