Individual provider Active NPI

Jack Maverick O'Hara

  • Student in an Organized Health Care Education/Training Program
  • Chapel Hill, NC
National Provider Identifier
1255278990
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
337870 Issued in NC
Practice address
590 Manning Dr
Chapel Hill, NC 27599-7595
Phone
(984) 974-4888
NPI assigned
Apr 30, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 337870 NC Primary

Addresses

Primary practice location

590 Manning Dr
Chapel Hill, NC 27599-7595

Mailing address

590 Manning Dr
Chapel Hill, NC 27599-7595
Phone (984) 974-4888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260504007296 NC Order and Referring Only - Family PracticePractitioner - Family Practice 5991273468

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
337870NCMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1777507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1255278990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MANNING DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275997595",
            "telephone_number": "984-974-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MANNING DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275997595",
            "telephone_number": "984-974-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'HARA",
        "first_name": "JACK",
        "middle_name": "MAVERICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-30",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "337870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

Verify at the official NPI Registry.