JACQUELINE MARIE CLARK RUHF, IDMT — NPI 1114240348 (Licensed & Credentialed Military Health Care Provider, Independent Duty Medical Technicians in WPAFB, OH)

CMS-1500 Box 24J / 33a • NPI

1114240348

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1710I1003X

Licensed & Credentialed Military Health Care Provider, Independent Duty Medical Technicians

Box 32 Service Location & ZIP+4

4881 SUGAR MAPLE DR, WPAFB, OH, 45433-5546

✓ 9-Digit EDI 837 ZIP+4 (45433-5546)

Practice Phone & Referral Fax

(937) 257-9519

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1114240348 (JACQUELINE MARIE CLARK RUHF, IDMT) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1114240348` (NPI-1 Individual Practitioner)
Provider / Legal Name	JACQUELINE MARIE CLARK RUHF, IDMT
Plain-English Specialty	Licensed & Credentialed Military Health Care Provider, Independent Duty Medical Technicians NUCC Code: `1710I1003X` (Military Health Care Provider, Independent Duty Medical Technicians)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4881 SUGAR MAPLE DR, WPAFB, OH, 45433-5546
Practice Telephone / Fax	Tel: (937) 257-9519
Administrative Mailing Address	805 PICKET PL, DAYTON, OH, 45433-1325
Enumeration & Last Sync	Enumerated: 2010-03-02 \| CMS Record Updated: 2010-03-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4881 SUGAR MAPLE DR, WPAFB, OH, 45433-5546

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Plain-English Taxonomy & CMS Crosswalk (1710I1003X)

What Does Taxonomy Code 1710I1003X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1710I1003X translates to:
"Licensed & Credentialed Military Health Care Provider, Independent Duty Medical Technicians"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Military Health Care Provider, Independent Duty Medical Technicians for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JACQUELINE MARIE CLARK RUHF, IDMT)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1710I1003X` — Military Health Care Provider, Independent Duty Medical Technicians Plain English: Licensed & Credentialed Military Health Care Provider, Independent Duty Medical Technicians	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JACQUELINE MARIE CLARK RUHF, IDMT (NPI #1114240348)