Active NPI
Jack McNulty
- Neurological Surgery Physician
- Iowa City, IA
National Provider Identifier
1407581606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- R-12624
- Practice address
- 200 Hawkins Dr
Iowa City, IA 52242-1009 - Phone
- (319) 353-8507
- NPI assigned
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | R-12624 | IA | Primary |
Addresses
Primary practice location
200 Hawkins Dr
Iowa City, IA 52242-1009
Mailing address
801 E 2ND Ave Apt 607
Coralville, IA 52241-2249
Phone (201) 421-8363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220803002344 | IA | Order and Referring Only - Neurosurgery | 9537541842 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-12624 | IA | MD | Neurological Surgery Physician |
Interoperability endpoints
- jack.mcnulty.1@28653.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1407581606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 E 2ND AVE APT 607",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "522412249",
"telephone_number": "201-421-8363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522421009",
"telephone_number": "319-353-8507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNULTY",
"first_name": "JACK",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-21",
"last_updated": "2022-07-21",
"certification_date": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "IA",
"license": "R-12624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.