Jacqueline Countryman, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

35-07-3384-C Issued in OH

Practice address

601 S Edwin C Moses Blvd
East Building, 4TH Floor
Dayton, OH 45408-1424

Phone

(937) 276-8333

NPI assigned

Jan 2, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Psychiatry

Education

Albany Medical College of Union University, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pbc.jacquelinecountryman@140098.advancedmd-direct.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.

• Psychological & Behavioral Consultants, LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Beachwood, OH
  • NPI 1811915713
  Medicare reassignment Care Compare group NPD
• Coleman Professional Services, Inc.

  • Mental Health Counselor
  • Kent, OH
  • NPI 1982637633

  Psychiatry

  Medicare reassignment NPD
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396802096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S EDWIN C MOSES BLVD",
            "address_2": "EAST BUILDING, 4TH FLOOR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454081424",
            "telephone_number": "937-276-8333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S EDWIN C MOSES BLVD",
            "address_2": "EAST BUILDING, 4TH FLOOR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454081424",
            "telephone_number": "937-276-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUNTRYMAN",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35-07-3384-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Couch, RESPIRATORY THERAPIS
• Meghan Michelle Couch, CRNA
• Angel Coughenour, PEER SUPPORT
• Angela M Coulter
• Redina Lee Counce
• Gail P Counts, PT
• Michelle Cournoyer, CDCA
• Victoria Courter
• Rachael Anne Courtney, D.O.
• Samantha Nicole Courtney, MD

• Psychiatry Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Psychiatry Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.