NPIMap

Individual provider Active NPI

Benjamin Jack, M.D.

  • Emergency Medicine Physician
  • Allentown, PA
National Provider Identifier
1346606001
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD465705 Issued in PA
Practice address
1200 S Cedar Crest Blvd
Allentown, PA 18103-6202
Phone
(484) 862-3232
NPI assigned
Jan 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 288093 NY
Emergency Medicine Physician 207P00000X MD465705 PA Primary

Addresses

Primary practice location

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

Mailing address

506 6TH St
Brooklyn, NY 11215-3609

Other practice location 1

506 6th St
Brooklyn, NY 11215-3609
Phone (718) 780-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181212000404 PA Practitioner - Emergency Medicine 2163766510 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
JS Weill Medical College, Cornell University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians
Emergency Physician Associates of Pennsylvania PCGroup PAC ID 5597663252, 88 clinicians

Practice addresses (Care Compare)

1200 S Cedar Crest Blvd
LVPG Emergency Medicine
Allentown, PA 18103-6202
Phone (610) 402-8111

700 E Norwegian St
Pottsville, PA 17901-2710
Phone (570) 621-4090

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
288093NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Oct 14, 2024 Accepting new patients
Jefferson Acute Care Physicians, PC Current Accepting new patients
Jefferson Acute Care Physicians, PC CurrentSince Jul 9, 2019 Accepting new patients
Emergency Physician Associates of Pennsylvania, PC Emergency Medicine CurrentSince Dec 1, 2018 Accepting new patients
Jefferson Acute Care Physicians, PC CurrentSince Jul 9, 2019 Accepting new patients
Lehigh Valley Physician Group Emergency Medicine Current Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 14, 2024 Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

1200 S Cedar Crest Blvd
Allentown, PA 18103
Phone (484) 862-3200

2966 Street Rd
Bensalem, PA 19020
Phone (215) 638-0666

1109 Grosser Rd
Gilbertsville, PA 19525
Phone (484) 498-6060

300 Highland Ave
Hanover, PA 17331
Phone (717) 316-3711

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

2451 Grant Ave
Philadelphia, PA 19114
Phone (215) 464-8050

700 E Norwegian St
Pottsville, PA 17901
Phone (570) 621-4000

320 W Pumping Station Rd
Quakertown, PA 18951
Phone (215) 529-4240

Organizations & group practices 8

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 5

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": "1452556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1346606001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 6TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112153609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CEDAR CREST BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036202",
            "telephone_number": "484-862-3232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 6th St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112153609",
            "country_code": "US",
            "telephone_number": "718-780-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-12",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "288093",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD465705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.