Jaclyn L Mascarin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601011637 Issued in MI

Practice address

1221 Pine Grove Ave
Port Huron, MI 48060-3511

Phone

(810) 989-3300

NPI assigned

Apr 9, 2013

Last updated

May 4, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in FL, MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Huron Emergency Medicine Specialists, PLLC

  • Emergency Medicine Physician
  • Port Huron, MI
  • NPI 1528686540
  Medicare reassignment
• Bay Area Emergency Physicians LLC

  • Emergency Medicine Physician
  • Clearwater, FL
  • NPI 1164459095
  Medicare reassignment
• Coastline Emergency Physicians LLC

  • Emergency Medicine Physician
  • Dunedin, FL
  • NPI 1891744769
  Medicare reassignment

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1639512791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 595498",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480595498",
            "telephone_number": "810-300-4887",
            "fax_number": "810-985-2671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 PINE GROVE AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603511",
            "telephone_number": "810-989-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Pinellas St # MS -36",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337563804",
            "country_code": "US",
            "telephone_number": "727-462-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASCARIN",
        "first_name": "JACLYN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-09",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107043",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa E Martin, LMSW
• Brandon Martindale
• Wendy Martindale, LMSW
• Marwan Shuayto MD PC (Blue Water Open MRI)
• Marwood Manor Nursing Home (Marwood Nursing & Rehab)
• Sammie M Matthews
• Lisa Mattson, LPC
• Annette Lynn Maxwell, LLPC
• Nancy Maxwell, LMSW
• Shilah Kay Maxwell, LLMSW

• Physician Assistant in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; 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.