Jaclyn Marie Walsh, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C5-0011436 Issued in DE

Practice address

1011 E Songsmith Dr
Bear, DE 19701-1194

Phone

(302) 918-7509

NPI assigned

Sep 24, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

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 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christiana Hospital Hospital, Newark, DE, CCN 080001

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jaclyn.keker@ghuccc.eclinicaldirectplus.com

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.

• Christiana Care Health Services, Inc

  dba CCHS Pmri

  • Endocrinology, Diabetes & Metabolism Physician
  • Wilmington, DE
  • NPI 1770568107
  Medicare reassignment Care Compare group
• Christiana Care Quality Partners

  dba ChristianaCare GoHealth Urgent Care

  • Urgent Care Clinic/Center
  • Newark, DE
  • NPI 1164061867
  Medicare reassignment
• Christiana Care Health Services, Inc

  dba CCHS Chief's Surgical Services

  • Surgery Physician
  • Wilmington, DE
  • NPI 1952385122
  NPD
• Christiana Care Health Services Inc

  dba CCHS Concord - Neurology

  • Neurology Physician
  • Chadds Ford, PA
  • NPI 1881228484
  NPD
• Christiana Care Health Services, Inc

  dba CCHS Satellite Offices

  • Family Medicine Physician
  • Hockessin, DE
  • NPI 1134104565

  Physician Assistant

  NPD (past)
• Christiana Care Quality Partners

  dba ChristianaCare GoHealth Urgent Care

  • Urgent Care Clinic/Center
  • Wilmington, DE
  • NPI 1881367332
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christiana Care Health Services, Inc.

  dba Christiana Care

  • General Acute Care Hospital
  • Wilmington, DE
  • NPI 1134194038
  Care Compare affiliation

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1801403878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 GRAND CANYON CT",
            "city": "BEAR",
            "state": "DE",
            "postal_code": "197011784",
            "telephone_number": "862-216-8434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 E SONGSMITH DR",
            "city": "BEAR",
            "state": "DE",
            "postal_code": "197011194",
            "telephone_number": "302-918-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-24",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0011436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Wadiak
• Heather H. Wagner, PHARM.D
• Walgreen Co (Walgreens #11022)
• Kelly Walker, DDS
• Terri Ann Wallace, RN
• Erin Bree Ward, PNP
• John J Wasniewski III, DMD
• Naieshia Watson
• Todd E Watson, DC
• Wayne Tucker DO, PA

• Physician Assistant in Bear, DE
• Providers in Bear, DE by specialty
• Physician Assistant in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.