JACKIE CLARK
NPI 1124474457
Occupational Therapist in Parrish, FL
About Jackie Clark NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKIE CLARK (NPI 1124474457) is an individual occupational therapist in Parrish, Florida, licensed in Florida (OT14395) and active in the NPI registry since May 2016. He is a graduate of Other (2010).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jackie Clark is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jackie Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Sarasota, FL 34240
- Reassigned Medicare billing, Florida enrollment
- 2 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jackie Clark's NPI number?
The NPI number for Jackie Clark is 1124474457. It was assigned to this individual provider in the NPPES registry on May 5, 2016.
Where is Jackie Clark located?
Jackie Clark practices at 11472 Walden Loop, Parrish, FL 34219. The listed phone number is (941) 806-7555.
What is Jackie Clark's specialty?
The primary specialty registered for this NPI is Occupational Therapist with taxonomy code 225X00000X.
Is Jackie Clark enrolled in Medicare?
Yes. Jackie Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jackie Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jackie Clark reassigns Medicare benefits to Smile Home Therapy LLC (Sarasota, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jackie Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jackie Clark was last updated on December 6, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.