NPIMap

Individual provider Active NPI

Stuart Andrew Jack

  • Internal Medicine Physician
  • Tulsa, OK
National Provider Identifier
1255950713
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME167093 Issued in FL
Practice address
4502 E 41St St
Tulsa, OK 74135-2536
Phone
(918) 619-4400
NPI assigned
Apr 14, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME167093 FL Primary
Internal Medicine Physician 207R00000X 35968 OK

Addresses

Primary practice location

4502 E 41St St
Tulsa, OK 74135-2536

Mailing address

3704 E 67TH St
Tulsa, OK 74136-2821
Phone (913) 708-0434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230419000408 OK Practitioner - Internal Medicine 9335514686 Reassigns benefits to 1 organization
I20240730004651 FL Practitioner - Internal Medicine 9335514686 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

Practice addresses (Care Compare)

13901 Bruce B Downs Blvd
Tampa, FL 33613-3905
Phone (813) 615-7260

3100 E Fletcher Ave
Tampa, FL 33613-4613
Phone (813) 615-7075

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.31 of 100Reported as group
Improvement activities
20
Cost
82.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME167093FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System-Sunbelt Inc CurrentSince Sep 11, 2024 Accepting new patients
Florida Hospital Physician Group Inc Internal Medicine CurrentSince Sep 11, 2024 Accepting new patients
Adventist Health System-Sunbelt Inc CurrentSince Sep 11, 2024 Accepting new patients
Tulsa Hospital Medicine Physicians Group, LLC Internal Medicine CurrentSince Apr 1, 2023 Accepting new patients
Adventist Health System-Sunbelt Inc Internal Medicine CurrentSince Sep 11, 2024 Accepting new patients

Locations

1210 US Highway 27 N
Lake Placid, FL 33852
Phone (863) 465-3777

13901 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 615-7260

13067 N Telecom Pkwy
Temple Terrace, FL 33637
Phone (813) 333-9108

522 Carlton St
Wauchula, FL 33873
Phone (863) 773-0975

2700 Healing Way
Ste 310
Wesley Chapel, FL 33543
Phone (813) 779-1209

10502 N 110th East Ave
Owasso, OK 74055
Phone (918) 376-8000

Organizations & group practices 5

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 6

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": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1255950713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3704 E 67TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741362821",
            "telephone_number": "913-708-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 E 41ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352536",
            "telephone_number": "918-619-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "STUART",
        "middle_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-14",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME167093",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "35968",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.