NPIMap

Individual provider Active NPI

Jennifer A Douglas, MD

  • Family Medicine Physician
  • Delmont, PA
National Provider Identifier
1861479792
Registry record updated Nov 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD422567 Issued in PA
Practice address
6521 Route 22
Delmont, PA 15626-2402
Phone
(724) 468-8764
Fax
(724) 468-8785
NPI assigned
Dec 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD422567 PA Primary
Hospitalist Physician 208M00000X MD422567 PA

Addresses

Primary practice location

6521 Route 22
Delmont, PA 15626-2402

Mailing address

6521 Route 22
Delmont, PA 15626-2402
Phone (724) 468-8764

Other identifiers 1

IdentifierTypeStateIssuer
1013584800003MedicaidPA

Other names 1

  • Jennifer A Shaulis Former name

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
I20040930000726 PA Practitioner - Family Practice 1557330008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pittsburgh School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excela Health Physician Practices, IncGroup PAC ID 6204737117, 474 clinicians

Practice addresses (Care Compare)

6521 Route 22
Delmont, PA 15626-2402
Phone (724) 468-8764

Hospital & facility affiliations

  • Excela Health Westmoreland Regional Hospital Hospital, Greensburg, PA, CCN 390145
  • Excela Health Latrobe Hospital Hospital, Latrobe, PA, CCN 390219
  • Excela Health - Frick Hospital Hospital, Mount Pleasant, PA, CCN 390217
  • Independence Health System Clarion Hospital Hospital, Clarion, PA, CCN 390093

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Excela Health Physician Practices, Inc. CurrentSince May 1, 2010 Accepting new patients
Excela Health Physician Practices, Inc. Family Medicine CurrentSince May 1, 2010 Accepting new patients
Excela Health Physician Practices, Inc Current Accepting new patients
Chestnut Ridge Primary Care, LTD Family Medicine Past Accepting new patients
Excela Health Physician Practices, Inc Past Accepting new patients
Westmoreland Regional Hospital Past Accepting new patients
Frick Hospital Past Accepting new patients
Excela Health Chestnut Ridge LLC Past Accepting new patients
Latrobe Area Hospital, Inc. Past Accepting new patients

Locations

6521 State Route 22
Delmont, PA 15626
Phone (724) 468-8764

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

555 State Route 217
Ste 1
Latrobe, PA 15650
Phone (724) 694-2723

508 S Church St
Mt Pleasant, PA 15666
Phone (724) 547-1500

Interoperability endpoints

  • Direct secure messaging: jdouglas@direct.excelahealth.org

Organizations & group practices 9

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385337600000",
    "number": "1861479792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6521 ROUTE 22",
            "city": "DELMONT",
            "state": "PA",
            "postal_code": "156262402",
            "telephone_number": "724-468-8764",
            "fax_number": "724-468-8785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6521 ROUTE 22",
            "city": "DELMONT",
            "state": "PA",
            "postal_code": "156262402",
            "telephone_number": "724-468-8764",
            "fax_number": "724-468-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-30",
        "last_updated": "2013-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD422567",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD422567",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013584800003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SHAULIS",
            "middle_name": "A",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Delmont, PA

Sources for this page

Verify at the official NPI Registry.