Jack Bryant Anon, M.D.

Key facts

NPI

1104877265

Entity type

Individual (NPI type 1)

Primary specialty

Otolaryngic Allergy Physician 207YX0602X

License

MD035571E (PA)

Practice address

1645 W 8TH St
Erie, PA 16505-5007

Phone

(814) 864-9994

Fax

(814) 866-2655

NPI assigned

May 13, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 2

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

• Ear Nose and Throat Specialists of Northwestern Pennsylvania Otolaryngology Physician · Erie, PA · NPI 1194754846
  Medicare reassignment Care Compare group NPD PA
• Ear Nose and Throat Specialists of Northwestern Pennsylvania Audiologist · Erie, PA · NPI 1710991559
  NPD (past)

Medicare Care Compare profile

Specialty

Otolaryngology

Education

University of Cincinnati College of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear Nose and Throat Specialists of Northwestern Pennsylvania (9 clinicians)

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

74.27 of 100 (group)

Quality

48.53

Improvement activities

40

Medicare participation

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jackanon@entsnwpa.allscriptsdirect.net

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 27, 2021.

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1104877265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165055007",
            "telephone_number": "814-864-9994",
            "fax_number": "814-866-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165055007",
            "telephone_number": "814-864-9994",
            "fax_number": "814-866-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANON",
        "first_name": "JACK",
        "middle_name": "BRYANT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "PA",
            "license": "MD035571E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010476830001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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