Jack Vibbert, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO.2148 Issued in AL

Practice address

70 Plaza Dr
Pell City, AL 35125-9314

Phone

(205) 814-9284

Fax

(205) 814-9626

NPI assigned

Nov 2, 2017

Last updated

Jun 12, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Birmingham Internal Medicine Associates, LLCGroup PAC ID 1658341193, 123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Compassus Home Health Home health agency, Pell City, AL, CCN 017145

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.vibbert.1@15135.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Birmingham Internal Medicine Associates, LLC

  • Internal Medicine Physician
  • Birmingham, AL
  • NPI 1598796542

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Inri Medical Associates, PC

  • Family Medicine Physician
  • Pell City, AL
  • NPI 1831103837
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Vincent's Home Health, LLC

  dba Ascension at Home

  • Home Health Agency
  • Pell City, AL
  • NPI 1497862551
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1063924868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 PLAZA DR",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351259314",
            "telephone_number": "205-814-9284",
            "fax_number": "205-814-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 PLAZA DR",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351259314",
            "telephone_number": "205-814-9284",
            "fax_number": "205-814-9626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7201 Happy Hollow Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Trussville",
            "state": "AL",
            "postal_code": "351732459",
            "country_code": "US",
            "telephone_number": "205-655-3721",
            "fax_number": "205-655-3814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2152 Old Springville Rd",
            "address_purpose": "LOCATION",
            "city": "Center Point",
            "state": "AL",
            "postal_code": "352154005",
            "country_code": "US",
            "telephone_number": "205-838-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIBBERT",
        "first_name": "JACK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-02",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "L4569R",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO.2148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wal-Mart Stores East LP (Walmart Pharmacy 10-5113)
• Wal-Mart Stores East, LP (Vision Center 30-5113)
• Camille Waldon

• Family Medicine Physician in Pell City, AL
• Providers in Pell City, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.