Jason M Zack, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101259277 Issued in VA

Practice address

4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098

Phone

(573) 596-1769

Fax

(573) 596-1783

NPI assigned

Jun 13, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

Specialty

Dermatology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Winneshiek Medical CenterGroup PAC ID 4688582935, shared by 9 NPIs, 99 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Winnmed Hospital, Decorah, IA, CCN 161371

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 and National Provider Directory roles.

• Winneshiek Medical Center

  • Critical Access Hospital
  • Decorah, IA
  • NPI 1619922051
  Medicare reassignment NPD
• Winneshiek Medical Center

  • Multi-Specialty Clinic/Center
  • Decorah, IA
  • NPI 1992854863
  Medicare reassignment NPD
• Winneshiek Medical Center

  • Community/Retail Pharmacy
  • Decorah, IA
  • NPI 1104507060
  NPD

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

• Winneshiek Medical Center

  • Critical Access Hospital
  • Decorah, IA
  • NPI 1619922051
  Care Compare affiliation

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1255745691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-1769",
            "fax_number": "573-596-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-1769",
            "fax_number": "573-596-1783"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 MONTGOMERY ST",
            "address_purpose": "LOCATION",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "country_code": "US",
            "telephone_number": "563-382-2911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZACK",
        "first_name": "JASON",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-13",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "MD53344",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101259277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yucheng Wu
• Angela Beth Wyatt, BSN
• Deborah A Yamnitz, LCSW
• Gail Lynn Young
• April Renee Zack, NP
• Paul M. Ziegler
• Brandon Lee Zimmer

• Dermatology Physician in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.