Gregory Bruce Jack, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

000758 Issued in CT

Practice address

50 Academy Hill Road
Plainfield, CT 06374

Phone

(860) 564-3015

Fax

(860) 564-3025

NPI assigned

Oct 3, 2006

Last updated

Nov 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Day Kimball Healthcare, Inc.Group PAC ID 5092773549, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Day Kimball Hospital Hospital, Putnam, CT, CCN 070003

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gregory.jack.1@29658.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.

• Day Kimball Healthcare, Inc.

  • General Acute Care Hospital
  • Putnam, CT
  • NPI 1649243478
  Medicare reassignment Care Compare group NPD
• Day Kimball Healthcare, Inc.

  • Community/Behavioral Health Agency
  • Putnam, CT
  • NPI 1104680966
  NPD
• Day Kimball Healthcare, Inc.

  • General Acute Care Hospital
  • Putnam, CT
  • NPI 1205056371
  NPD
• University Pathologists, LLC

  • Anatomic Pathology Physician
  • Providence, RI
  • NPI 1568640886
  NPD

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

• Day Kimball Healthcare, Inc.

  • General Acute Care Hospital
  • Putnam, CT
  • NPI 1205056371
  Care Compare affiliation
• Day Kimball Healthcare, Inc.

  • General Acute Care Hospital
  • Putnam, CT
  • NPI 1649243478
  Care Compare affiliation

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1164517512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 ACADEMY HILL ROAD, P.O. BOX 201",
            "city": "PLAINFIELD",
            "state": "CT",
            "postal_code": "06374",
            "telephone_number": "860-564-3015",
            "fax_number": "860-564-3025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ACADEMY HILL ROAD",
            "city": "PLAINFIELD",
            "state": "CT",
            "postal_code": "06374",
            "telephone_number": "860-564-3015",
            "fax_number": "860-564-3025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "GREGORY",
        "middle_name": "BRUCE",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "000758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Honeylet Alonte Ibia, P.T.
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• Adithi Karthikeyan, DDS
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• Professional Counselor in Plainfield, CT
• Providers in Plainfield, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; 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.