JACQUELINE CLUBINE (CNM) – Advanced Practice Midwife, NPI 1053812362
Advanced Practice Midwife
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JACQUELINE CLUBINE (CNM)
PO BOX 850
PORT ANGELES, WA 983620146
Phone: (360) 565-0999
Type: Mailing
433 E 8TH ST
PORT ANGELES, WA 983626219
Phone: (360) 565-0999
Type: Location
1135 WOODLAND AVE NE APT 7
ATLANTA, GA 303244401
Phone: (910) 705-2836
Type: Mailing
520, Boulevard Northeast, Atlanta, Fulton County, Georgia, 30308, United States
ATLANTA, GA 303124211
Phone: (404) 265-2800
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $55.
Total Amount is formed as General ($55) + Research ($0) + Ownership ($0) = $55.
Last reported payment date: 2024-08-20 • Largest payer in this snapshot: OptumHealth Care Solutions, LLC ($55).
Total Amount
$55
General + Research + Ownership
Payments
2
Total payment records
General Amount
$55
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| OptumHealth Care Solutions, LLC | $55 |
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: 2024-05-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20180713002259 | I | Certified Nurse Midwife (Cnm) | GA | TBD |
| I20240523001674 | I | Certified Nurse Midwife (Cnm) | WA | 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 98362)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| - | GA | |
| - | GA | |
| R H E U M A T O L O G Y | MI | |
| Hospitalist, Internal Medicine | GA | |
| Nurse Practitioner | TN | |
| Family Practice | GA | |
| Physician Assistant | GA | |
| Physician Assistant | GA | |
| Hospitalist, Internal Medicine | GA |
Reviews
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