Jaclynn Marie Thacker, APRN, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71011761A Issued in IN

Practice address

420 W Longest St
Paoli, IN 47454-8821

Phone

(812) 723-3944

NPI assigned

Sep 17, 2021

Last updated

Jul 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Indiana Community Health Care IncGroup PAC ID 5799694360, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Paoli Hospital Hospital, Paoli, IN, CCN 151306

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jaclynnthacker@sichc.allscriptsdirect.net

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.

• Southern Indiana Community Health Care, Inc

  dba Comprehensive Health Care

  • Family Medicine Physician
  • Paoli, IN
  • NPI 1427171057
  Medicare reassignment Care Compare group NPD
• Southern Indiana Community Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Bedford, IN
  • NPI 1407566631
  NPD
• Southern Indiana Community Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Orleans, IN
  • NPI 1356911390
  NPD (past)
• Southern Indiana Community Health Care, Inc

  dba Comprehensive Health Care

  • Federally Qualified Health Center (FQHC)
  • Paoli, IN
  • NPI 1386151371
  NPD (past)
• Southern Indiana Community Health Care, Inc

  dba Patoka Family Health Care

  • Family Medicine Physician
  • English, IN
  • NPI 1457474009
  NPD (past)
• Southern Indiana Community Health Care, Inc

  dba Patoka Family Health Care

  • Federally Qualified Health Center (FQHC)
  • English, IN
  • NPI 1629585591
  NPD (past)

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

• Indiana University Health Paoli Inc

  dba IU Health Paoli

  • Critical Access Hospital
  • Paoli, IN
  • NPI 1912984451
  Care Compare affiliation

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1073283362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W LONGEST ST",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474548821",
            "telephone_number": "812-723-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W LONGEST ST",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474548821",
            "telephone_number": "812-723-3944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "307 S Indiana Ave",
            "address_purpose": "LOCATION",
            "city": "English",
            "state": "IN",
            "postal_code": "471185851",
            "country_code": "US",
            "telephone_number": "812-338-2924",
            "fax_number": "812-338-5851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THACKER",
        "first_name": "JACLYNN",
        "middle_name": "MARIE",
        "credential": "APRN, NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71011761A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300058325",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Stroud, P.T.
• Heather Sturgill
• Veronika Sukupova, LSW
• Brandy Terrell, LCSW
• Heather L. Terwiske, MSW, LSW
• Total Renal Care Inc (Paoli Dialysis)
• Michael K Vanemon, DDS
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2563)
• Jill Walker, MA CCC-SLP
• Linda Carol Wells-Freiberger, N.P.

• Family Nurse Practitioner in Paoli, IN
• Providers in Paoli, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.