NPIMap

Individual provider Active NPI

Jacqulin Fabina

  • Family Medicine Physician
  • Williamsburg, PA
National Provider Identifier
1730409509
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS015975 Issued in PA
Practice address
306 Plum St
Williamsburg, PA 16693-1116
Phone
(814) 832-3405
NPI assigned
Jun 3, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS015975 PA Primary

Addresses

Primary practice location

306 Plum St
Williamsburg, PA 16693-1116

Mailing address

306 Plum St
Williamsburg, PA 16693-1116

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jacqulin.fabina@upmcdirect.com UPMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131022001283 PA Practitioner - Family Practice 6305071606 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upmc AltoonaGroup PAC ID 8426962465, 126 clinicians

Practice addresses (Care Compare)

306 Plum St
Williamsburg, PA 16693-1116
Phone (814) 832-3405

501 Howard Ave
Altoona, PA 16601-4818
Phone (814) 889-2701

Hospital & facility affiliations

  • Aseracare Hospice Hospice, Altoona, PA, CCN 391655
  • Gentiva II Hospice, Altoona, PA, CCN 391657
  • Upmc Altoona Hospital, Altoona, PA, CCN 390073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS015975PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upmc Altoona CurrentSince Aug 1, 2013 Accepting new patients
Upmc Altoona Past Accepting new patients
Upmc Altoona Past Accepting new patients

Locations

620 Howard Ave
Altoona, PA 16601
Phone (814) 889-2011

501 Howard Ave
Ste F2
Altoona, PA 16601
Phone (814) 889-2020

9498 William Penn Hwy
Huntingdon, PA 16652
Phone (814) 643-0461

306 Plum St
Williamsburg, PA 16693
Phone (814) 832-3405

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aseracare HospiceAltoona, PA, CCN 391655 Hospice Contracted Managing Employee Oct 10, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 6

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": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1730409509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 PLUM ST",
            "city": "WILLIAMSBURG",
            "state": "PA",
            "postal_code": "166931116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 PLUM ST",
            "city": "WILLIAMSBURG",
            "state": "PA",
            "postal_code": "166931116",
            "telephone_number": "814-832-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABINA",
        "first_name": "JACQULIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS015975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacqulin.fabina@upmcdirect.com",
            "affiliation": "Y",
            "affiliationName": "UPMC",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsburg, PA

Sources for this page

Verify at the official NPI Registry.