Individual provider Active NPI

Jaclyn Maureen Laine, D.O.

  • Clinical Neurophysiology Physician
  • Columbus, OH
National Provider Identifier
1316146988
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
34.010195 Issued in OH
Practice address
1480 W Lane Ave
Columbus, OH 43221-3919
Phone
(614) 533-5500
Fax
(614) 533-0103
NPI assigned
Jul 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 34.010195 OH
Clinical Neurophysiology Physician 2084N0600X 34.010195 OH Primary
Epilepsy Physician 2084E0001X 34.010195 OH

Addresses

Primary practice location

1480 W Lane Ave
Columbus, OH 43221-3919

Mailing address

PO Box 7527
Dublin, OH 43017-0727

Other identifiers 1

IdentifierTypeStateIssuer
0061403MedicaidOH

Other names 1

  • Jaclyn Maureen Drake Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jlaine12792@direct.ohiohealth.com OhioHealth Physician Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120723000810 OH Practitioner - Neurology 6002072881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Ohio University, College of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

1010 Refugee Rd
Pickerington, OH 43147-9653

1030 Refugee Rd
Suite 300
Pickerington, OH 43147-9653
Phone (614) 566-2286

1040 Delaware Ave
Marion, OH 43302-6416
Phone (614) 533-5500

1050 Delaware Ave
Marion, OH 43302-6416
Phone (740) 375-6489

111 S Grant Ave
Columbus, OH 43215-4701

111 S Grant Ave 3Rd FL
Columbus, OH 43215-4701
Phone (614) 566-9184

335 Glessner Ave
Mansfield, OH 44903-2269

3535 Olentangy River Rd
Columbus, OH 43214-3908

393 E Town St
Columbus, OH 43215-4799

5100 W Broad St
Columbus, OH 43228-1607
Phone (614) 544-2058

5154 W Braod St
Suite 150
Columbus, OH 43228-1607
Phone (614) 566-0774

55 Hospital Dr
Athens, OH 45701-2302
Phone (740) 593-5551

65 Hospital Dr
Athens, OH 45701-2302
Phone (740) 566-4890

65 Hospital Dr Cornwell Ctr
Mid Ohio Cardio
Athens, OH 45701-2302
Phone (740) 566-4890

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.04 of 100Reported as group
Quality
58.67
Promoting interoperability
98
Improvement activities
40
Cost
76.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.010195OHMDEpilepsy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Jul 31, 2012 Accepting new patients
Ohiohealth Corporation CurrentSince Jul 31, 2012 Accepting new patients
Ohiohealth Corporation Internal Medicine CurrentSince Aug 4, 2024 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Ohiohealth Corporation Past Accepting new patients

Locations

931 Chatham Ln
Ste 200
Columbus, OH 43221

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

Dept L3652
Columbus, OH 43260

5400 Frantz Rd
Ste 250
Dublin, OH 43016
Phone (614) 544-6161

1480 W Lane Ave
Upper Arlington, OH 43221

Organizations & group practices 5

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 7

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": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1316146988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7527",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430170727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 W LANE AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432213919",
            "telephone_number": "614-533-5500",
            "fax_number": "614-533-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAINE",
        "first_name": "JACLYN",
        "middle_name": "MAUREEN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-13",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "34.010195",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "OH",
            "license": "34.010195",
            "primary": true
        },
        {
            "code": "2084E0001X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Epilepsy",
            "state": "OH",
            "license": "34.010195",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0061403",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlaine12792@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group, Inc.",
            "address_1": "1480 W Lane Ave",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "432213919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "DRAKE",
            "middle_name": "MAUREEN",
            "credential": "D.O,",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.