Jackeline Gomez, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

15661 Issued in NH

Practice address

23511 Hollywood Rd
Suite 2
Leonardtown, MD 20650-5833

Phone

(301) 997-0611

Fax

(301) 997-0709

NPI assigned

Jun 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Internal Medicine

Education

University of Puerto Rico School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medstar Health Home Care Home health agency, Hyattsville, MD, CCN 217150
• Chesapeake - Potomac Home Health Agency, Inc. Home health agency, Hughesville, MD, CCN 217138
• Medstar Saint Mary'S Hospital Hospital, Leonardtown, MD, CCN 210028

Merit-based Incentive Payment System (MIPS)

Final score

82.34 of 100Reported as group

Quality

67.9

Promoting interoperability

100

Improvement activities

40

Cost

69.47

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment Care Compare group NPD
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD (past)
• Spartanburg Medical Center

  • Physical Medicine & Rehabilitation Physician
  • Spartanburg, SC
  • NPI 1942188875
  NPD (past)
• Wentworth Douglass Physician Corporation

  • Diagnostic Radiology Physician
  • Somersworth, NH
  • NPI 1295326494
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Chesapeake-Potomac Home Health Agency, Inc

  • Home Health Agency
  • Hughesville, MD
  • NPI 1184627234
  Care Compare affiliation
• Medstar Health Visiting Nurse Association, Inc.

  • Home Health Agency
  • Greenbelt, MD
  • NPI 1154437879
  Care Compare affiliation
• St Marys Hospital of St Marys County Inc

  • General Acute Care Hospital
  • Leonardtown, MD
  • NPI 1780650473
  Care Compare affiliation

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406073600000",
    "number": "1992745152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23511 HOLLYWOOD RD",
            "address_2": "SUITE 2",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206505833",
            "telephone_number": "301-997-0611",
            "fax_number": "301-997-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23511 HOLLYWOOD RD",
            "address_2": "SUITE 2",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206505833",
            "telephone_number": "301-997-0611",
            "fax_number": "301-997-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "JACKELINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "15661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3076395",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992745152",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruth Diana Gerson, CNM
• Megan Gessford
• Emalie Jean Gibbons Baker, CNM
• Amanda Gibson
• Jenna Leigh Glynn, DPT
• Grace by Faith, LLC
• Greater Baden Medical Service Incorporated
• Greater Maryland Pain Management, LLC
• Erika Lashawn Greene, ADT
• Emily A Grisnik, PA-C

• Internal Medicine Physician in Leonardtown, MD
• Providers in Leonardtown, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.