JACKIE VANNUYEN (MD) – Obstetrics & Gynecology Physician, NPI 1710961651

JACKIE VANNUYEN (MD) is a healthcare provider. based in Sylvania, Ohio. specializing in OBSTETRICS/GYNECOLOGY. They hold the professional credentials MD. They hold a License No. 35.086025 (OH). The NPI Number for JACKIE VANNUYEN (MD) is 1710961651

Main info

Female
31 Years Of Experience
Accepts Medicare Assignment
Name
JACKIE VANNUYEN (MD)
NPI
1710961651
Phone
(419) 824-5640
Address
5300 HARROUN RD
Enumeration Date
5 December 2005
Last Update Date
3 November 2023

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF OHIO
Secondary Phone
4195787700
Graduation Year
1995 (31 years ago)
PAC ID
3971518960
Group Practice PAC ID
2365348190
Professional Enrollment ID
I20060213000367
Address ID
OH436060000TO2901XRDXX400

Contacts

Secure Messaging
jvannuyen7621@epicdirect.promedica.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness85
Years active:20State licenses:1Other namesUpdated within 12 months

1,818 OBSTETRICS/GYNECOLOGY in OH

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Provider Addresses for JACKIE VANNUYEN (MD)

  • 5300, Harroun Road, Sylvania, Lucas County, Ohio, 43560, United States

    SUITE 226

    SYLVANIA, OH 435602182

    Phone: (419) 824-5640

    Fax: (419) 824-5744

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 39 Open Payments records for all available years, with a total value of $751.

Total Amount is formed as General ($751) + Research ($0) + Ownership ($0) = $751.

Last reported payment date: 2024-11-11 • Largest payer in this snapshot: Sumitomo Pharma America, Inc. ($117).

Total Amount

$751

General + Research + Ownership

Payments

39

Total payment records

General Amount

$751

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-11

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2006-02-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20060213000367IObstetrics/GynecologyOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43560)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2365348190View full group profile
NameSpecialtyState
-OH
Certified Registered Nurse Anesthetist (Crna)OH
-OH
-OH
-OH
Nurse PractitionerOH
-OH
Certified Registered Nurse Anesthetist (Crna)TX
-OH
-OH

Reviews

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Frequently asked questions

Can I use this page to confirm JACKIE VANNUYEN (MD)'s NPI?
Yes. JACKIE VANNUYEN (MD) is listed with NPI 1710961651 in the public NPI dataset.
Is JACKIE VANNUYEN (MD) listed as active for patients and plans?
The listing shows JACKIE VANNUYEN (MD) as active in the NPI system.
What is JACKIE VANNUYEN (MD)'s primary classification?
Obstetrics & Gynecology Physician is the headline specialty for JACKIE VANNUYEN (MD) here. Clinical services aligned with this taxonomy classification.
Does JACKIE VANNUYEN (MD) list a practice location?
Patients near Sylvania, Ohio may find JACKIE VANNUYEN (MD) in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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