Individual provider Active NPI

Jonette M McClelland, CRNP

  • Pediatric Nurse Practitioner
  • Washington, PA
National Provider Identifier
1912257551
Registry record updated Nov 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
SP012367 Issued in PA
Practice address
37 Highland Avenue
Washington, PA 15301-4062
Phone
(724) 223-1067
Fax
(724) 223-1088
NPI assigned
Sep 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X SP012367 PA Primary

Addresses

Primary practice location

37 Highland Avenue
Washington, PA 15301-4062

Mailing address

1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20211019002808 PA Practitioner - Nurse Practitioner 4688062938 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP012367PAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centerville Clinics, Inc. Current Accepting new patients
Centerville Clinics, Inc. Current Accepting new patients
Centerville Clinics Inc CurrentSince Oct 5, 2021 Accepting new patients
Centerville Clinics, Inc. Current Accepting new patients
Centerville Clinics, Inc. Current Accepting new patients
Centerville Clinics, Inc. Current Accepting new patients
Centerville Clinics, Inc CurrentSince Oct 5, 2021 Accepting new patients

Locations

1070 Old National Pike
Fredericktown, PA 15333

37 Highland Ave
Washington, PA 15301
Phone (724) 223-1067

Interoperability endpoints

  • Direct secure messaging: jonette.mcclelland.1@33484.direct.athenahealth.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636156800000",
    "number": "1912257551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 HIGHLAND AVENUE",
            "city": "WASHINGTON",
            "state": "PA",
            "postal_code": "153014062",
            "telephone_number": "724-223-1067",
            "fax_number": "724-223-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAND",
        "first_name": "JONETTE",
        "middle_name": "M",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-11",
        "last_updated": "2021-11-06",
        "certification_date": "2021-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "SP012367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, PA

Sources for this page

Verify at the official NPI Registry.