Jennifer M Sample, PA-C - Medicare Physician Assistant in Mentor, OH

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Jennifer M Sample, PA-C is a medicare enrolled "Physician Assistant" in Mentor, Ohio. She graduated from nursing school in 2006 and has 20 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Cleveland Clinic and her current practice location is 9500 Mentor Ave, Suite 100, Mentor, Ohio. You can reach out to her office (for appointments etc.) via phone at (440) 352-4880.

Jennifer M Sample is licensed to practice in Ohio (license number 2541) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1902000714.

Contact Information

Jennifer M Sample, PA-C
9500 Mentor Ave, Suite 100,
Mentor, OH 44060-8713
(440) 352-4880
(440) 352-3629

Map and Direction




Provider's Profile

Full NameJennifer M Sample
GenderFemale
SpecialityPhysician Assistant
Experience20 Years
Location9500 Mentor Ave, Mentor, Ohio
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Jennifer M Sample graduated from nursing school in 2006
  NPI Data:
  • NPI Number: 1902000714
  • Provider Enumeration Date: 06/14/2007
  • Last Update Date: 04/08/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 3779620158
  • Enrollment ID: I20091019000155

Medical Identifiers

Medical identifiers for Jennifer M Sample such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1902000714NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 2541 (Ohio)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Fairview HospitalCleveland, OHHospital
Cleveland ClinicCleveland, OHHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Cleveland Clinic18502035556954

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jennifer M Sample allows following entities to bill medicare on her behalf.
Entity NameThe Cleveland Clinic Foundation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1679525919
PECOS PAC ID: 1850203555
Enrollment ID: O20031103000049
Entity NameEmergency Professional Services, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1093762353
PECOS PAC ID: 7214832435
Enrollment ID: O20040511000864
Entity NameUniversity Hospitals Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1669499414
PECOS PAC ID: 4789682493
Enrollment ID: O20061113000301
Entity NameUniversity Hospitals Geneva Medical Center
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1700261807
PECOS PAC ID: 1658568803
Enrollment ID: O20150918001686
Entity NameUniversity Hospitals Conneaut Medical Center
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1831545177
PECOS PAC ID: 0547429656
Enrollment ID: O20161107001012

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jennifer M Sample is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jennifer M Sample, PA-C
9500 Euclid Ave,
Cleveland, OH 44195-0001

Ph: (440) 445-4500		Jennifer M Sample, PA-C
9500 Mentor Ave, Suite 100,
Mentor, OH 44060-8713

Ph: (440) 352-4880

Reviews and Comments


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Gwyneth Ellen Markowitz, PA
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Phone: 440-357-2770    Fax: 440-354-4669
Mrs. Adrienne Marie Colabuno, PA-C
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Madisyn Rempe,
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Phone: 440-496-6133    Fax: 440-283-3010
Kelley L. Pastor, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 9220 Mentor Ave, Mentor, OH 44060
Phone: 440-354-9924    Fax: 877-242-9583

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.