PROF. JACKIE LEAH CLARK PHD
NPI 1417951484
Audiologist in Tool, TX
About Prof. Jackie Leah Clark Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROF. JACKIE LEAH CLARK PHD (NPI 1417951484) is an individual audiologist in Tool, Texas and active in the NPI registry since June 2005. She is a graduate of Other (1995).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
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
Prof. Jackie Leah Clark Phd 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.
Dallas, TX 75235
- Reassigned Medicare billing, Texas enrollment
- 16 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 75143 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 1417951484. It was assigned to this individual provider in the NPPES registry on June 8, 2005.
Where is Jackie Clark located?
Jackie Clark practices at 601 S Tool Dr, Tool, TX 75143. The listed phone number is (903) 432-1932.
What is Jackie Clark's specialty?
The primary specialty registered for this NPI is Audiologist with taxonomy code 231H00000X.
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 University Of Texas At Dallas (Dallas, TX). 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 October 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Prof. Jackie Leah Clark, PHD · NPI 1417951484
Audiologist provider in Tool, Texas. Individual provider, active in the CMS NPPES registry since June 8, 2005.
## Identity
- **NPI:** 1417951484 (Entity type: Individual)
- **Enumerated:** June 8, 2005
- **Primary specialty:** Audiologist · taxonomy 231H00000X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 601 S TOOL DR, Tool, TX 75143-1959
- **Phone:** (903) 432-1932 · **Fax:** (903) 432-0520
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** University Of Texas At Dallas (NPI 1770559973, Dallas, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1995
## Record status
- **NPPES last updated:** October 28, 2020
- **Other identifiers:** Other 66993 (TX)
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Source: [NPI Profile](https://npiprofile.com/npi/1417951484) · Data from the CMS NPPES public registry.