JACLYN NOEL MARIE JEZAK (CNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1922764760
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
14,989 NURSE PRACTITIONER in OH
Provider Addresses for JACLYN NOEL MARIE JEZAK (CNP)
4300 CHAMPLIN DR
PERRYSBURG, OH 435517178
Phone: (419) 266-5297
Type: Mailing
710 CLEVELAND AVE
FREMONT, OH 434203224
Phone: (419) 334-6619
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 87 Open Payments records for all available years, with a total value of $2,281.
Total Amount is formed as General ($2,281) + Research ($0) + Ownership ($0) = $2,281.
Last reported payment date: 2024-12-12 • Largest payer in this snapshot: ABBVIE INC. ($395).
Total Amount
$2,281
General + Research + Ownership
Payments
87
Total payment records
General Amount
$2,281
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $395 |
| GlaxoSmithKline, LLC. | $250 |
| ITI, Inc. (d/b/a Intra-Cellular Therapies, Inc.) | $236 |
| Alkermes, Inc. | $228 |
| IRONSHORE PHARMACEUTICALS INC. | $182 |
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: 2022-02-02
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 |
|---|---|---|---|---|
| I20220202001870 | I | Nurse Practitioner | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 60 | 12 | $0 |
Insurance plans in this area (ZIP 43551)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| - | OH | |
| - | OH | |
| - | OH | |
| Nurse Practitioner | OH | |
| - | OH | |
| Certified Registered Nurse Anesthetist (Crna) | TX | |
| - | OH | |
| - | OH |
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