Jaclyn Marie Dematteis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

OA003932 Issued in PA

Practice address

101 Applied Bank Blvd Ste 11
Glen Mills, PA 19342

Phone

(484) 800-8630

Fax

(484) 800-8635

NPI assigned

Sep 17, 2013

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1265585806
  NPD (past)

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

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1699101055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 APPLIED BANK BLVD STE 11",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "19342",
            "telephone_number": "484-800-8630",
            "fax_number": "484-800-8635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1855 Powder Mill Rd",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174024723",
            "country_code": "US",
            "telephone_number": "717-718-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "825 Old Lancaster Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Bryn Mawr",
            "state": "PA",
            "postal_code": "190103239",
            "country_code": "US",
            "telephone_number": "610-542-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Applied Bank Blvd Ste 11",
            "address_purpose": "LOCATION",
            "city": "Glen Mills",
            "state": "PA",
            "postal_code": "19342",
            "country_code": "US",
            "telephone_number": "484-800-8630",
            "fax_number": "484-800-8635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMATTEIS",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-17",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001137",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA003932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John De Wolf
• Katherine Grace Deatrich, PSY.D.
• Delaware Hospice, Inc.
• Delaware Valley Anesthesia LLC
• Jason Delcollo, DO
• Lauren Dengler
• Robert P. Denitzio, MD
• Dental Health Solutions,LLC
• Dental Professionals of Pennsylvania, PC
• Barbara A Dentinger

• Physician Assistant in Glen Mills, PA
• Providers in Glen Mills, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.