Individual provider Active NPI

Jaclyn M Peddle, CRNA

  • Certified Registered Nurse Anesthetist
  • Falmouth, MA
National Provider Identifier
1679909303
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2289121 Issued in MA
Practice address
100 Ter Heun Dr
Falmouth, MA 02540-2503
Phone
(508) 457-3580
NPI assigned
Sep 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2289121 MA Primary
Certified Registered Nurse Anesthetist 367500000X 345574 OH

Addresses

Primary practice location

100 Ter Heun Dr
Falmouth, MA 02540-2503

Mailing address

100 Ter Heun Dr
Falmouth, MA 02540-2503
Phone (508) 457-3580

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160202002407 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 2860620242 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

1 Park W Blvd
Suite 260
Akron, OH 44320-4231
Phone (330) 864-6000

1000 E Washington St
Medina, OH 44256-2170
Phone (330) 725-1000

12300 McCracken Rd
Garfield Heights, OH 44125-2914

16761 Southpark Ctr
Strongsville, OH 44136-9302
Phone (440) 878-2500

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

  • Medina Hospital Hospital, Medina, OH, CCN 360091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
2289121MAMDCertified Registered Nurse Anesthetist
345574OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Ohio LLC CurrentSince Jan 1, 2016 Accepting new patients
The Cleveland Clinic Foundation Nurse Anesthetist, Certified Registered CurrentSince Aug 15, 2016 Accepting new patients
Wooster Clinic, LLC CurrentSince Jan 1, 2016 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6780 Mayfield Rd
Mayfield Hts, OH 44124
Phone (440) 331-9520

12301 Snow Rd
Parma Heights, OH 44130
Phone (216) 285-8810

2615 E High St
Springfield, OH 45505
Phone (888) 861-3994

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1380153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1679909303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TER HEUN DR",
            "city": "FALMOUTH",
            "state": "MA",
            "postal_code": "025402503",
            "telephone_number": "508-457-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TER HEUN DR",
            "city": "FALMOUTH",
            "state": "MA",
            "postal_code": "025402503",
            "telephone_number": "508-457-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDLE",
        "first_name": "JACLYN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-26",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "2289121",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "345574",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falmouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.