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THERESA MCCLAIN D.O.
NPI 1235573916
Obstetrics & Gynecology in Allentown, PA

Active since April 24, 2013PECOS EnrolledAccepts Medicare Assignment
71.53/100
CMS Quality Rating
1611 POND RD STE 300, ALLENTOWN, PA 18104(610) 398-7700(610) 398-3917 Get Directions Write a Review

NPPES record last updated: January 13, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 13, 2026, Aug 9, 2021, Jan 31, 2019 and 2 more (5 updates tracked since 2018).

About Theresa Mcclain D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THERESA MCCLAIN D.O. (NPI 1235573916) is an individual obstetrics & gynecology provider in Allentown, Pennsylvania, licensed in Pennsylvania (OS018924) and active in the NPI registry since April 2013. She is enrolled in Medicare PECOS, is affiliated with Penn State Health St. Joseph, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1235573916
Entity TypeIndividualFemale
Primary Taxonomy207V00000X
Provider Legal NameTHERESA MCCLAINCredential: D.O.
Location Address1611 POND RD STE 300Allentown, PA 18104
Mailing Address2494 Bernville Rd Ste 100Reading, PA 19605-9466 · (610) 378-2899 · Fax (610) 378-2980
Phone(610) 398-7700
Fax(610) 398-3917
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateApril 24, 2013
Last NPPES UpdateJanuary 13, 20265 updates tracked since enumeration
NPPES CertifiedJanuary 13, 2026
✔ NPI 1235573916 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in PA · OS018924
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1611 POND RD STE 300, Allentown, PA 18104
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1500 University DrHershey, PA 17033-2360 · Phone (800) 243-1455
Location 21330 Penn AveWyomissing, PA 19610 · Phone (610) 373-3738 · Fax (610) 373-4938

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

Theresa Mcclain D.o. 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.

PECOS PAC ID8022302561
PECOS Enrollment IDI20171106000062
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Theresa Mcclain reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

St. Joseph Medical Group
27 mi
Primary Care
403 N 13TH ST
Reading, PA 19604
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 251 clinicians in this Medicare group
NPI 1750590881 (610) 375-8577
Penn State Health Medical Group, LLC
28 mi
Orthopaedic Surgery
2494 BERNVILLE RD STE 200
Reading, PA 19605
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 994 clinicians in this Medicare group
NPI 1942955521 (610) 378-2996
The Milton S Hershey Medical Center Physicians Group
63 mi
Pediatrics
35 HOPE DR
Hershey, PA 17033
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 2,216 clinicians in this Medicare group
NPI 1205801537 (800) 243-1455

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

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.

Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101
This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.
33 services33 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Penn State Health St. Joseph

Acute Care Hospitals · Reading, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390096
Location2500 Bernville RoadReading, PA 19605 · Berks County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 18104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$126.34 typical visit price
range $54.64 – $166.87
Typical copayment $31.58 (range $13.66 – $41.71)
Most-billed visit code 99204
Established Patient
$68.36 typical visit price
range $17.33 – $135.84
Typical copayment $17.09 (range $4.33 – $33.96)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

71.53/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality55.53
Promoting Interoperability100
Improvement Activities40
Cost49.57

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ALEXIS JACQUELINE ACHEY LEWIS DO
Obstetrics & Gynecology
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
ANN SHERIDAN VALE M.D.
Obstetrics & Gynecology
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
DEVON CAREY SMITH D.O.
Obstetrics & Gynecology (Urogynecology and Reconstructive Pelvic Surgery)
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
REBECCA LANGLEY CNM
Midwife
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
HONI TRAUGER CNM
Advanced Practice Midwife
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
KATHLEEN MARY PULICE DO
Obstetrics & Gynecology
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
KAITLYN LAWRENCE PA-C
Physician Assistant (Medical)
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700
ANNMARIE MCDERMOTT M.D.
Obstetrics & Gynecology
1611 POND RD STE 300
ALLENTOWN, PA 18104
Lehigh County (610) 398-7700

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 Theresa Mcclain's NPI number?

The NPI number for Theresa Mcclain is 1235573916. It was assigned to this individual provider in the NPPES registry on April 24, 2013.

Where is Theresa Mcclain located?

Theresa Mcclain practices at 1611 Pond Rd Ste 300, Allentown, PA 18104. The listed phone number is (610) 398-7700.

What is Theresa Mcclain's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Theresa Mcclain enrolled in Medicare?

Yes. Theresa Mcclain 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 organizations bill Medicare for Theresa Mcclain's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theresa Mcclain reassigns Medicare benefits to 3 organizations: St. Joseph Medical Group (Reading, PA), Penn State Health Medical Group, LLC (Reading, PA) and The Milton S Hershey Medical Center Physicians Group (Hershey, PA). Each 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 Theresa Mcclain's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Theresa Mcclain affiliated with any hospitals?

According to CMS data, Theresa Mcclain is affiliated with Penn State Health St. Joseph.

When was this NPI record last updated?

The NPPES record for Theresa Mcclain was last updated on January 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.