Momodu A Jack, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD20286 Issued in DC

Practice address

2139 Georgia Ave NW
Suite 3a
Washington, DC 20001-3035

Phone

(202) 865-7981

Fax

(301) 621-5313

NPI assigned

Sep 21, 2006

Last updated

Nov 6, 2020By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

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 2

Specialty

GastroenterologyAlso: Internal Medicine

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Howard University Hospital Corp Hospital, Washington, DC, CCN 090003

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  Gastroenterology

  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD

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

• Howard University Hospital Corp

  • General Acute Care Hospital
  • Washington, DC
  • NPI 1487740957
  Care Compare affiliation

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1164521019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2325",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210451325",
            "telephone_number": "202-865-7981",
            "fax_number": "301-621-5313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2139 GEORGIA AVE NW",
            "address_2": "SUITE 3A",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200013035",
            "telephone_number": "202-865-7981",
            "fax_number": "301-621-5313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "541 Sunset Ln Ste 301",
            "address_purpose": "LOCATION",
            "city": "Culpeper",
            "state": "VA",
            "postal_code": "227013979",
            "country_code": "US",
            "telephone_number": "540-825-4557",
            "fax_number": "540-825-4566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "MOMODU",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MD",
            "license": "D0044035",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VA",
            "license": "0101270422",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "DC",
            "license": "MD20286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyne T Jabosung
• Jack Burton Strength and Conditioning LLC
• Fay D Jack
• Joanne Jack
• Lennard Jack Jr., P.T.
• Ebonique Jacks
• Iman Jacks
• Jackson Marriage and Family Counseling Services
• Latosha Jackson Martin
• Anjelica E Jackson Todd, PSY.D.

• Gastroenterology Physician in Washington, DC
• Providers in Washington, DC by specialty
• Gastroenterology Physician in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.