Active NPI
Jack Edward Hubbard Jr., PH.D., M.D.
- Neurology Physician
- Burnsville, MN
National Provider Identifier
1194772103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 24157
- Practice address
- 675 E Nicollet Blvd
Suite 100
Burnsville, MN 55337-6749 - Phone
- (952) 435-8516
- Fax
- (763) 302-4336
- NPI assigned
- May 27, 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 24157 | MN | Primary |
Addresses
Primary practice location
675 E Nicollet Blvd
Suite 100
Burnsville, MN 55337-6749
Mailing address
675 E Nicollet Blvd
Suite 100
Burnsville, MN 55337-6749
Phone (952) 435-8516
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0265006 | Other | MN | PREFERRED ONE |
| 0506197 | Other | MN | MEDICA |
| HP13563 | Other | MN | HEALTHPARTNERS |
| 829007500 | Medicaid | MN | |
| 22668 | Other | MN | AMERICA'S PPO |
| 30478600 | Medicaid | WI | |
| 07483HU | Other | MN | BCBS OF MN |
| 100285C029 | Other | MN | UCARE |
| 130004281 | Other | MN | 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, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24157 | MN | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322697600000",
"number": "1194772103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 E NICOLLET BLVD",
"address_2": "SUITE 100",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553376749",
"telephone_number": "952-435-8516",
"fax_number": "763-302-4336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 E NICOLLET BLVD",
"address_2": "SUITE 100",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553376749",
"telephone_number": "952-435-8516",
"fax_number": "763-302-4336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBBARD",
"first_name": "JACK",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PH.D., M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-27",
"last_updated": "2011-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MN",
"license": "24157",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "0265006",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "0506197",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP13563",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "829007500",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "22668",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30478600",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MN",
"identifier": "07483HU",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "100285C029",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "130004281",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.