Jessica Porcelan, MD
Individual provider Active NPI Psychiatry Physician · Wpafb, OH
NPI 1053869735 · NPPES record last updated May 23, 2025
Key facts
- NPI
- 1053869735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 57.029289 (OH)
- Practice address
- 4881 Sugar Maple Dr
Wpafb, OH 45433-5529 - Phone
- (937) 257-6877
- NPI assigned
- Sep 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Access Ohio LLC
Practice addresses (Care Compare)
2611 Wayne Ave
Dayton, OH 45420-1833
Phone (937) 228-0579
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211201002949 | OH | Practitioner - Psychiatry | 9638441025 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57.029289 | OH | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Ohio, LLC | Current |
Accepting new patients | |
| Access Ohio, LLC | Current |
Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Locations
8100 Ravines Edge Ct
Ste 200
Columbus, OH 43235
Phone (614) 655-3345
6400 E Broad St
Ste 400
Columbus, OH 43213
Phone (614) 367-7700
2611 Wayne Ave
Dayton, OH 45420
Phone (937) 228-0579
2611 Wayne Ave
Bldg 61
Dayton, OH 45420
Phone (937) 228-0579
Interoperability endpoints
- jessica.porcelan.1@415.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 57.029289 | OH | Yes |
Addresses
Primary practice location
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Mailing address
113 Lielmanis Ave
Hurlburt Field, FL 32544-5613
Other practice location 1
2611 Wayne Ave
Dayton, OH 45420-1833
Phone (937) 367-2146
Other providers in Wpafb, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.