Jacquelyn Helena Clark, M.D.
Individual provider Active NPI Family Medicine Physician · Waynesboro, PA
NPI 1205327293 · NPPES record last updated Feb 2, 2023
Key facts
- NPI
- 1205327293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD473102 (PA)
- Practice address
- 1051 E Main St Ste 1
Waynesboro, PA 17268-2318 - Phone
- (717) 762-9118
- NPI assigned
- May 24, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Pennsylvania State University College of Medicine, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Waynesboro Family Medical Associates, LLP
Practice addresses (Care Compare)
1051 E Main St
Suite 1
Waynesboro, PA 17268-2318
Phone (717) 762-9118
Hospital & facility affiliations
- Wellspan Vna Home Care
- Residential Home Health of Carlisle, LLC
- Advantage Home Health and Hospice
- Wellspan Waynesboro Hospital
- Wellspan Chambersburg Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20210608001174 | PA | Practitioner - Family Practice | 2062768112 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waynesboro Family Medical Associates, LLP | Family Medicine | Current |
Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
1051 E Main St
Ste 1
Waynesboro, PA 17268
Phone (717) 762-9118
Interoperability endpoints
- j.clark@waynesborofma.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD473102 | PA | Yes |
Addresses
Primary practice location
1051 E Main St Ste 1
Waynesboro, PA 17268-2318
Mailing address
1051 E Main St Ste 1
Waynesboro, PA 17268-2318
Phone (717) 762-9118
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | j.gallo@waynesborofma.medentdirect.com |
Other providers in Waynesboro, PA
- Care Plus Oxygen, Inc.
- Lori Cassatt
- Benita Ann Casto
- Centers for Advanced Orthopaedics, LLC
- Cho Cho
- Sherol Clarke
- Anthony Colangelo
- David A Collins
- Timothy Lee Cool
- Cornerstone Family Dentistry,LLC
All providers in Waynesboro, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2023. 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.