Kathryn E Jack, APRN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

002455 Issued in CT

Practice address

455 Lewis Ave
Suite 106
Meriden, CT 06451-2121

Phone

(203) 886-0036

Fax

(203) 886-0072

NPI assigned

Jul 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Connecticut Gi PLLCGroup PAC ID 9830110758, 243 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.99 of 100Reported as group

Quality

89.16

Promoting interoperability

100

Improvement activities

40

Cost

78.45

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kathryn.jack@xdr.hhchealthdirect.org

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.

• Connecticut Gi PLLC

  • Gastroenterology Physician
  • Hartford, CT
  • NPI 1023124625

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Litchfield County Gastroenterology Associates, LLC

  • Gastroenterology Physician
  • Torrington, CT
  • NPI 1871513283
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1265456347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2139 SILAS DEANE HWY",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060672336",
            "telephone_number": "860-257-4131",
            "fax_number": "860-257-4519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 LEWIS AVE",
            "address_2": "SUITE 106",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512121",
            "telephone_number": "203-886-0036",
            "fax_number": "203-886-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "KATHRYN",
        "middle_name": "E",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "002455",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "002455",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "002455",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004219491",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana Marie Irish
• Jaime Irizarry, DMD
• John Emery -------------------- Istvan, LCSW
• Brandon Ito, PA-C
• Itopia LLC
• Jacquelyn Meyer Aprn, PLLC
• Joanna Jakubowska, M.D.
• Krzysztof Jakubowski, MD
• Estelle Jeter
• Tameka Jeter

• Adult Health Nurse Practitioner in Meriden, CT
• Providers in Meriden, CT by specialty
• Adult Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; 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.