Jackie Lee Quach, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35.121203 Issued in OH

Practice address

1040 Delaware Ave
Marion, OH 43302-6416

Phone

(740) 383-8090

Fax

(740) 375-6481

NPI assigned

Sep 28, 2012

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

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Marion Area Physicians LLC

  • Internal Medicine Physician
  • Marion, OH
  • NPI 1619230802

  Pediatrics

  Medicare reassignment NPD
• Ohiohealth Corporation

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1578545273
  Medicare reassignment NPD
• Ohiohealth Corporation

  • Anesthesiology Physician
  • Columbus, OH
  • NPI 1407292105
  NPD

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

{
    "created_epoch": "1348790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1396096418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "# L-3652",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432606453",
            "telephone_number": "740-383-7927",
            "fax_number": "740-383-7942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 DELAWARE AVE",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433026416",
            "telephone_number": "740-383-8090",
            "fax_number": "740-375-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUACH",
        "first_name": "JACKIE",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-28",
        "last_updated": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A119861",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.121203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0087085",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jquach107191@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group",
            "address_1": "1040 Delaware Ave",
            "city": "Marion",
            "state": "OH",
            "country_code": "US",
            "postal_code": "433026416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sara Provenzale
• Joel D Provenzano, M.D.
• Mario William Puleo II, MD
• Ming Hong Pun, DDS
• Tarlok S Purewal, M D
• Kai Quin, M.D.
• Corri R. Rabun, RPH
• Bhola Nath Rama, MD
• Kimberly Diane Ramey, LCDC III
• Carolina Ramirez, ED.S, LSP

• Pediatrics Physician in Marion, OH
• Providers in Marion, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.