Richard Anthony Jack, M.D.

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

C175889 Issued in CA

Practice address

18321 Clark St
Tarzana, CA 91356-3501

Phone

(818) 708-5570

Fax

(818) 708-5471

NPI assigned

Apr 10, 2013

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 HI

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

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.

• Hawaii Permanente Medical Group Inc

  • Health Maintenance Organization
  • Honolulu, HI
  • NPI 1710945969
  Medicare reassignment NPD
• Kapiolani Medical Specialists

  • Multi-Specialty Clinic/Center
  • Honolulu, HI
  • NPI 1124071014
  Medicare reassignment NPD
• Queens North Hawaii Community Hospital

  • Orthopaedic Surgery Physician
  • Kamuela, HI
  • NPI 1528049814
  Medicare reassignment NPD
• Kapiolani Medical Center for Women & Children

  • Multi-Specialty Clinic/Center
  • Honolulu, HI
  • NPI 1548215692
  Medicare reassignment
• North Hawaii Community Hospital, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kamuela, HI
  • NPI 1033190319
  NPD
• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Honolulu, HI
  • NPI 1396813861
  NPD (past)
• Kapiolani Medical Center for Women & Children

  • Children's Hospital
  • Honolulu, HI
  • NPI 1043263080
  NPD (past)

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1306289129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 W 190TH ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905045513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18321 CLARK ST",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563501",
            "telephone_number": "818-708-5570",
            "fax_number": "818-708-5471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 University Dr",
            "address_2": "H085",
            "address_purpose": "LOCATION",
            "city": "Hershey",
            "state": "PA",
            "postal_code": "170332360",
            "country_code": "US",
            "telephone_number": "917-405-2405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "RICHARD",
        "middle_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "C175889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iwil LLC
• Alexandra Marie Izuno
• J Ezra MD, Inc.
• Deanna Marie Jabourian
• Jack a. Bayramyan DDS Inc
• Jackie Kreitzman and Associates
• Danielle Jackson
• Robert Warren Jackson
• Sebastian Sky Jacob
• Sharon Jacobs-Cohen, SLP

• Neonatal-Perinatal Medicine Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Neonatal-Perinatal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.