NPIMap

Individual provider Active NPI

James Kyle Jack, PA-C

  • Physician Assistant
  • Chico, CA
National Provider Identifier
1205069234
Registry record updated Jan 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1555 Springfield Dr
Chico, CA 95928-6398
Phone
(530) 433-9633
Fax
(530) 433-9634
NPI assigned
Aug 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1555 Springfield Dr
Chico, CA 95928-6398

Mailing address

1331 N Elm St
Suite 200
Greensboro, NC 27401-6302
Phone (336) 274-9617

Other names 1

  • Prof. Kyle Jack Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120815000253 CA Practitioner - Physician Assistant 7810036241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Enloe Medical CenterGroup PAC ID 9739092388, 330 clinicians

Practice addresses (Care Compare)

1531 Esplanade
Chico, CA 95926-3310
Phone (530) 332-7300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.49 of 100Reported as group
Quality
60.52
Promoting interoperability
100
Improvement activities
40
Cost
68.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
22241CAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Enloe Medical Center CurrentSince Aug 11, 2018 Accepting new patients
Enloe Medical Center CurrentSince Aug 11, 2018 Accepting new patients
Enloe Medical Center Past Accepting new patients
North State Radiology Medical Group Inc Past Accepting new patients
Enloe Medical Center Past Accepting new patients
North State Radiology Medical Group Inc Past Accepting new patients
Chico Health Imaging Medical Group, P.C. Past Accepting new patients

Locations

1600 Esplanade
Ste C
Chico, CA 95926
Phone (530) 332-4470

1555 Springfield Dr
Chico, CA 95928
Phone (530) 332-6200

Interoperability endpoints

  • Direct secure messaging: jjack11908@enloedirect.org

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454025600000",
    "number": "1205069234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 N ELM ST",
            "address_2": "SUITE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274016302",
            "telephone_number": "336-274-9617",
            "fax_number": "336-482-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SPRINGFIELD DR",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959286398",
            "telephone_number": "530-433-9633",
            "fax_number": "530-433-9634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "JAMES",
        "middle_name": "KYLE",
        "name_prefix": "Prof.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-25",
        "last_updated": "2016-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLE",
            "last_name": "JACK",
            "prefix": "PROF.",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chico, CA

Sources for this page

Verify at the official NPI Registry.