Jacqueline L Cleland, CNM
Individual provider Active NPI Women's Health Nurse Practitioner · Newark, OH
NPI 1285961805 · NPPES record last updated Jan 26, 2024
Key facts
- NPI
- 1285961805
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Women's Health Nurse Practitioner 363LW0102X
- License
- APRN.CNP.022750 (OH)
- Practice address
- 20 W Locust St
Newark, OH 43055-5520 - Phone
- (220) 564-7940
- Fax
- (220) 564-7941
- NPI assigned
- Nov 4, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Licking Memorial Health Professionals
Practice addresses (Care Compare)
20 W Locust St
Newark, OH 43055-5520
Phone (220) 564-4835
Hospital & facility affiliations
- Licking Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.98 of 100
- Quality
- 75.66
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.38
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091125000451 | OH | Practitioner - Certified Nurse Midwife (CNM) | 4789723057 | Reassigns benefits to 1 organization |
| I20201120002045 | OH | Practitioner - Nurse Practitioner | 4789723057 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA.11118-NM | OH | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Licking Memorial Professional Corporation | Current |
Accepting new patients | |
| Muskingum Valley Health Centers | Current |
Accepting new patients | |
| Muskingum Valley Health Centers | Current |
Accepting new patients | |
| Muskingum Valley Health Centers | Current |
Accepting new patients | |
| Muskingum Valley Health Centers | Current | Accepting new patients | |
| Licking Memorial Health Professionals | Current |
Accepting new patients | |
| Licking Memorial Hospital | Current | Accepting new patients | |
| Licking Memorial Professional Corp. | Past | Accepting new patients | |
| Licking Memorial Professional Corp. | Past | Accepting new patients |
Locations
1330 Clark St
Cambridge, OH 43725
Phone (740) 421-9530
316 Clark St
Cambridge, OH 43725
Phone (740) 432-7600
1230 Clark St
Cambridge, OH 43725
Phone (740) 439-9911
440 Browns Ln
Coshocton, OH 43812
Phone (740) 295-3331
450 Downtowner Plz
Coshocton, OH 43812
Phone (740) 487-3110
1205 Cambridge Rd
#100
Coshocton, OH 43812
Phone (740) 622-9433
406 S 15th St
Coshocton, OH 43812
Phone (740) 295-3331
859 N Main St
Malta, OH 43758
Phone (740) 962-6111
20 W Locust St
Newark, OH 43055
Phone (220) 564-4835
120 McMillen Dr
Newark, OH 43055
Phone (220) 564-4806
33 S 5th St
Zanesville, OH 43701
Phone (407) 891-9000
915 Putnam Ave
Zanesville, OH 43701
Phone (407) 891-9000
716 Adair Ave
Zanesville, OH 43701
Phone (740) 454-5239
2725 Pinkerton Ln
Zanesville, OH 43701
Phone (740) 487-3348
Interoperability endpoints
- jcleland@lickingmemorial.medicity.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | COA.11118-NM | OH | |
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | APRN.CNP.022750 | OH | |
| Advanced Practice Midwife | 367A00000X | COA.11118-NM | OH | |
| Women's Health Nurse Practitioner | 363LW0102X | APRN.CNP.022750 | OH | Yes |
Addresses
Primary practice location
20 W Locust St
Newark, OH 43055-5520
Mailing address
20 W Locust St
Newark, OH 43055-5520
Phone (220) 564-7940
Other practice location 1
859 N Main St
Malta, OH 43758-9007
Phone (740) 962-6111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3015016 | Medicaid | OH |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jcleland35963@lickingmemorial.medicity.net |
Other providers in Newark, OH
- Abigail Clark
- Kimberly Clark
- Linda G Clark
- Clear Choice Audiology, LLC
- Diana Cleland
- Adam J Clemens
- Jonda V. Clemings
- Amy L. Coble
- Bobbi Jo Cochran
- Lindsey R Cochran
All providers in Newark, OH · Women's Health Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2024. 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.