Prof Jackie Leah Clark, PHD is a medicare enrolled "Audiologist" provider in Tool, Texas. She graduated from medical school in 1995 and has 29 years of diverse experience with area of expertise as Qualified Audiologist. Her current practice location is
601 S Tool Dr, Tool, Texas. You can reach out to her office (for appointments etc.) via phone at
(903) 432-1932.
Prof Jackie Leah Clark is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1417951484.
Healthcare Provider's Profile
| Full Name | Prof Jackie Leah Clark |
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| Gender | Female |
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| Speciality | Qualified Audiologist |
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| Experience | 29 Years |
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| Location | 601 S Tool Dr, Tool, Texas |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Prof Jackie Leah Clark graduated from medical school in 1995
NPI Data:
- NPI Number: 1417951484
- Provider Enumeration Date: 06/08/2005
- Last Update Date: 10/28/2020
Medicare PECOS Information:
- PECOS PAC ID: 7214930627
- Enrollment ID: I20060824000067
Medical Identifiers
Medical identifiers for Prof Jackie Leah Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417951484 | NPI | - | NPPES |
| 66993 | Other | TX | CSHCN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 231H00000X | Audiologist | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Prof Jackie Leah Clark allows following entities to bill medicare on her behalf.
| Provider Name | University Of Texas At Dallas |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1770559973
PECOS PAC ID: 7810971207
Enrollment ID: O20040614001723 |
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| Provider Name | Cedar Creek Hearing Center |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1962439257
PECOS PAC ID: 3678576089
Enrollment ID: O20060824000059 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Prof Jackie Leah Clark is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Prof Jackie Leah Clark, PHD
5038 Creekwood Dr,
Flower Mound, TX 75028-1913
Ph: (972) 539-8558 | Prof Jackie Leah Clark, PHD
601 S Tool Dr,
Tool, TX 75143-1959
Ph: (903) 432-1932 |
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