NPIMap

Individual provider Active NPI

Jacquelyn Helena Clark, M.D.

  • Family Medicine Physician
  • Waynesboro, PA
National Provider Identifier
1205327293
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD473102 Issued in PA
Practice address
1051 E Main St Ste 1
Waynesboro, PA 17268-2318
Phone
(717) 762-9118
NPI assigned
May 24, 2018
Last updated
Feb 2, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD473102 PA Primary

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 1

TypeEndpointUseAffiliation
Direct Messaging Address j.gallo@waynesborofma.medentdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210608001174 PA Practitioner - Family Practice 2062768112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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, LLPGroup PAC ID 8325934508, 5 clinicians

Practice addresses (Care Compare)

1051 E Main St
Suite 1
Waynesboro, PA 17268-2318
Phone (717) 762-9118

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Waynesboro Family Medical Associates, LLP Family Medicine CurrentSince Jul 19, 2021 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

  • Direct secure messaging: j.clark@waynesborofma.medentdirect.com
  • Direct secure messaging: j.gallo@waynesborofma.medentdirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1205327293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 E MAIN ST STE 1",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-762-9118",
            "fax_number": "717-762-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 E MAIN ST STE 1",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-762-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JACQUELYN",
        "middle_name": "HELENA",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-24",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD473102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "j.gallo@waynesborofma.medentdirect.com",
            "affiliation": "N",
            "address_1": "1051 E Main St Ste 1",
            "city": "Waynesboro",
            "state": "PA",
            "country_code": "US",
            "postal_code": "172682318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waynesboro, PA

Sources for this page

Verify at the official NPI Registry.