Jacquelyn Geraldine Small, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02007766A Issued in IN

Practice address

3909 New Vision Dr
Fort Wayne, IN 46845-1725

Phone

(260) 469-6610

Fax

(260) 969-3065

NPI assigned

May 15, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 4

Medicare fee-for-service enrollment

Enrolled in MI, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Michigan State University College of Osteopathic Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsmall795930@direct.hfhs.org
• Direct secure messaging: jsmall96297@direct.covenanthealthcare.com
• Direct secure messaging: jsmall656449@direct.parkviewexchange.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Parkview Health System Inc

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment Care Compare group NPD
• Parkview Wabash Hospital, Inc.

  • Family Medicine Physician
  • Wabash, IN
  • NPI 1891176590
  Medicare reassignment NPD
• Covenant Medical Center, Inc.

  • Emergency Medicine Physician
  • Saginaw, MI
  • NPI 1972590412
  Medicare reassignment NPD
• Parkview Wabash Hospital, Inc.

  • Rural Health Clinic/Center
  • Wabash, IN
  • NPI 1982103511
  NPD
• Covenant Medical Center, Inc

  • Family Medicine Physician
  • Saginaw, MI
  • NPI 1619412376
  NPD
• Covenant Medical Center, Inc.

  • Urgent Care Clinic/Center
  • Saginaw, MI
  • NPI 1831244466
  NPD
• Parkview Health System,Inc.

  • Gastroenterology Physician
  • Fort Wayne, IN
  • NPI 1437461449
  NPD (past)

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

• Parkview Hospital, Inc.

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1225694102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451725",
            "telephone_number": "260-469-6610",
            "fax_number": "260-969-3065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALL",
        "first_name": "JACQUELYN",
        "middle_name": "GERALDINE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-15",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101025847",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02007766A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsmall96297@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "27450 Schoenherr Rd Ste 400",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480886684",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsmall656449@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Slyby, D.D.S.
• Roland Fred Slyby, DDS
• Laura Smaling
• Small Steps - Giant Leaps, Inc.
• Small Talk Speech Therapy LLC
• Roy Small, DO
• Heather C Smalley, CADAC II
• Logan T Smead
• Aisha-Amina Smiley, MSW
• Krystal Smiley, RBT

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.