Active NPI
Robert A Jack, M.D.
- Psychiatry Physician
- Franklin, TN
National Provider Identifier
1104804764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD13141
- Practice address
- 2010 Quail Hollow Cir
Franklin, TN 37067-5967 - Phone
- (615) 807-4020
- Fax
- (615) 807-4022
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD13141 | TN | Primary |
Addresses
Primary practice location
2010 Quail Hollow Cir
Franklin, TN 37067-5967
Mailing address
PO Box 682749
Franklin, TN 37068-2749
Phone (615) 807-4020
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3025734 | Medicaid | TN | |
| 35759 | Other | TN | BCBS |
| 1588204 | Other | TN | UNITED HEALTHCARE |
| 260010800 | Other | TN | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD13141 | TN | MD | Psychiatry Physician |
| 13141 | TN | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250640000000",
"number": "1104804764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 682749",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370682749",
"telephone_number": "615-807-4020",
"fax_number": "615-807-4022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 QUAIL HOLLOW CIR",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370675967",
"telephone_number": "615-807-4020",
"fax_number": "615-807-4022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-04",
"last_updated": "2009-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "MD13141",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3025734",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "35759",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1588204",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "260010800",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Franklin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.