Jaclynn Pauline Back, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.13665 Issued in OH

Practice address

1445 W Main St
Newark, OH 43055-1989

Phone

(513) 834-7063

Fax

(513) 873-1567

NPI assigned

Oct 3, 2012

Last updated

Oct 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 OH, NC, OR, WA4 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 4

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Boulder Care Provider Group PAGroup PAC ID 6901217447, 115 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Boulder Care Provider Group PA

  dba Boulder Care

  • Addiction Medicine (Family Medicine) Physician
  • Portland, OR
  • NPI 1649838590

  NC, OH, WA

  Medicare reassignment Care Compare group NPD
• Brightview, LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Cincinnati, OH
  • NPI 1659769446
  Medicare reassignment
• Brightview LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Asheboro, NC
  • NPI 1962163782
  NPD

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

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1770835506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MONTGOMERY RD STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551989",
            "telephone_number": "513-834-7063",
            "fax_number": "513-873-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACK",
        "first_name": "JACLYNN",
        "middle_name": "PAULINE",
        "name_prefix": "Miss",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-03",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.13665",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.313249",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn Health Care of Newark
• Autumn Health Care of Thornville, Inc.
• Angela Bacak, PSY.S
• Makayla Bachelor, RN
• Heidi Back, RDMS, RVT
• Jonathan Kent Bafford, D.C.
• Crea Lynn Bailey
• Ginger Marie Bailey, R.N.
• Leann Bailey
• Georgia Bain

• Family Nurse Practitioner in Newark, OH
• Providers in Newark, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.