Jaclyn Azzara, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA059548 Issued in PA

Practice address

1203 Langhorne Newtown Rd Ste 226
Langhorne, PA 19047-1224

Phone

(215) 710-5522

Fax

(215) 710-5181

NPI assigned

Dec 1, 2017

Last updated

Jan 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ, PA2 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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trinity Health Mid-Atlantic Medical GroupGroup PAC ID 7416861885, 350 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary Medical Center Hospital, Langhorne, PA, CCN 390258

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD
• Direct secure messaging: jfudala2020233@direct.trinity-health.org

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.

• Trinity Health Mid-Atlantic Medical Group

  dba THMA MG Surgical Associates Holme

  • Surgery Physician
  • Langhorne, PA
  • NPI 1972982361
  Medicare reassignment Care Compare group
• Hackensack Meridian Health Medical Group - Specialty Care PC

  dba HMHMG Specialty Care

  • Surgical Critical Care Physician
  • Red Bank, NJ
  • NPI 1215989249
  Medicare reassignment NPD
• Trinity Health Mid-Atlantic Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Philadelphia, PA
  • NPI 1639039175
  NPD
• Trinity Health Mid-Atlantic Medical Group

  dba Langhorne Internal Medicine

  • Hospitalist Physician
  • Langhorne, PA
  • NPI 1902114804
  NPD
• Hackensack Meridian Health Medical Group - Specialty Care PC

  dba HMMG New Jersey Oral & Maxillofacial Surgery

  • Durable Medical Equipment & Medical Supplies
  • North Bergen, NJ
  • NPI 1215734199
  NPD
• Trinity Health Mid-Atlantic Medical Group

  dba THMA MG Trauma Service Langhorne

  • Trauma Surgery Physician
  • Langhorne, PA
  • NPI 1093771271
  NPD (past)
• Hackensack Meridian Health Medical Group - Complex Care PC

  dba HMHMG Complex Care

  • Internal Medicine Physician
  • Red Bank, NJ
  • NPI 1154379626
  NPD (past)

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

• St Mary Medical Center

  • General Acute Care Hospital
  • Langhorne, PA
  • NPI 1780686931
  Care Compare affiliation

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

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1013422856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 UNIVERSITY DR STE 300",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189401873",
            "telephone_number": "215-710-5522",
            "fax_number": "215-710-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 LANGHORNE NEWTOWN RD STE 226",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471224",
            "telephone_number": "215-710-5522",
            "fax_number": "215-710-5181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076011915",
            "country_code": "US",
            "telephone_number": "551-996-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZZARA",
        "first_name": "JACLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-01",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA004390",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00457000",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jaclyn.fudala.1@11127.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "SMMC Direct E-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1203 Langhorne Newtown Rd Ste 226",
            "city": "Langhorne",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190471224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John A Avallone, DO
• Venice A Aviso, DDS
• Axis Diagnostics, Inc.
• Kristen Ayrer, CRNP- AGPCNP
• Saodat Azizova
• Rebecca Azzi
• B. Grazyna Dudkowska, M.D.
• April Leigh Bacani, BSW
• Alan Bader, PHD
• Bagnell Chiropractic Life Centre (Bagnell Chiropractic Life CTR.)

• Physician Assistant in Langhorne, PA
• Providers in Langhorne, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.