NPIMap

Individual provider Active NPI

Jennifer M Sample, PA-C

  • Physician Assistant
  • Mentor, OH
National Provider Identifier
1902000714
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2541 Issued in OH
Practice address
9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713
Phone
(440) 352-4880
Fax
(440) 352-3629
NPI assigned
Jun 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2541 OH Primary

Addresses

Primary practice location

9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713

Mailing address

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (440) 445-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20091019000155 OH Practitioner - Physician Assistant 3779620158 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

18101 Lorain Ave
Cleveland, OH 44111-5612
Phone (216) 671-2205

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

  • Fairview Hospital Hospital, Cleveland, OH, CCN 360077
  • Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2541OHMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospitals Medical Group Inc CurrentSince Nov 7, 2022 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Sep 22, 2009 Accepting new patients
University Hospitals Conneaut Medical Center Physician Assistant CurrentSince Jun 26, 2021 Accepting new patients
University Hospitals Conneaut Medical Center CurrentSince Jun 26, 2021 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Sep 22, 2009 Accepting new patients
Signature Health Inc PastSince Apr 1, 2017 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

11100 Euclid Ave
Cleveland Heights, OH 44106

158 W Main Rd
Conneaut, OH 44030
Phone (216) 844-3777

870 W Main St
Geneva, OH 44041
Phone (440) 415-0258

18697 Bagley Rd
Middleburg Heights, OH 44130
Phone (440) 816-8000

Interoperability endpoints

  • Direct secure messaging: jsample75701@ehrdirect.uhhospitals.org

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Signature Health, Inc.Painesville, OH, CCN 361124 Federally qualified health center Corporate Director Apr 1, 2017
Signature Health, Inc.Ashtabula, OH, CCN 361131 Federally qualified health center Corporate Director Apr 1, 2017
Signature Health, Inc.Maple Heights, OH, CCN 361132 Federally qualified health center Corporate Director Apr 1, 2017
Signature Health, Inc.Beachwood, OH, CCN 361147 Federally qualified health center Corporate Director Apr 1, 2017
Signature Health, Inc.Lakewood, OH, CCN 361181 Federally qualified health center Corporate Director Apr 1, 2017
Signature Health, Inc.Willoughby, OH, CCN D21025 Federally qualified health center Corporate Director Apr 1, 2017

Owned or controlled facilities with NPI records 6

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

Organizations & group practices 8

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 2

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1902000714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "440-445-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVE",
            "address_2": "SUITE 100",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608713",
            "telephone_number": "440-352-4880",
            "fax_number": "440-352-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "2541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.