JENNIFER M SAMPLE (PA-C) – Physician Assistant, NPI 1902000714
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,032 PHYSICIAN ASSISTANT in OH
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Provider Addresses for JENNIFER M SAMPLE (PA-C)
Mentor Avenue, Mentor, Lake County, Ohio, 44060, United States
SUITE 100
MENTOR, OH 440608713
Phone: (440) 352-4880
Fax: (440) 352-3629
Type: Mailing
9500 EUCLID AVE
CLEVELAND, OH 441950001
Phone: (440) 445-4500
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $26.
Total Amount is formed as General ($26) + Research ($0) + Ownership ($0) = $26.
Last reported payment date: 2024-10-16 • Largest payer in this snapshot: CSL Behring ($26).
Total Amount
$26
General + Research + Ownership
Payments
1
Total payment records
General Amount
$26
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-16
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CSL Behring | $26 |
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: 2009-10-19
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20091019000155 | I | Physician Assistant | OH | TBD |
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.
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 44060)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | OH | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 13 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | NV | |
| Nephrology, Internal Medicine | OH | |
| - | OH | |
| - | MI | |
| Nurse Practitioner | OH | |
| General Surgery, Anesthesiology, Critical Care (Intensivists) | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| - | OH | |
| - | MN | |
| Nurse Practitioner | OH |
Reviews
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