Active NPI
Marcus Jack
- Professional Counselor
- Chicago, IL
National Provider Identifier
1306591342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180014299
- Practice address
- 12400 S Michigan Ave
Chicago, IL 60628-7347 - Phone
- (770) 912-5225
- NPI assigned
- Feb 17, 2022
- Last updated
- Feb 17, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180014299 | IL | Primary |
Addresses
Primary practice location
12400 S Michigan Ave
Chicago, IL 60628-7347
Mailing address
5640 Stone CT
Stone Mountain, GA 30087-2954
Phone (770) 912-5225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Professional | Current | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
605 N Michigan Ave
Fl 4
Chicago, IL 60611
Phone (773) 232-5338
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645056000000",
"number": "1306591342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5640 STONE CT",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300872954",
"telephone_number": "770-912-5225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12400 S MICHIGAN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606287347",
"telephone_number": "770-912-5225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "MARCUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-17",
"last_updated": "2022-02-17",
"certification_date": "2022-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180014299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
- Jack D. Clemis, MD SC
- Jack M Bulmash MDSC
- Jack S. Litz, D.D.S., LTD.
- Jack Shaw Superior Eye Care (superior eye care)
- Jack Zoldan, MD LTD
- Jackie the Social Worker
- Barbara Jacks, MD
- Jackson Cila Care Inc
- Jackson Corp (Jackson Square Nursing & Rehab Center)
- Jackson Corp (Jackson Square Nursing & Rehab Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.