NPIMap

Individual provider Active NPI

Jack Cole Noble, MD

  • Family Medicine Physician
  • Bastrop, LA
National Provider Identifier
1447233036
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
014889 Issued in LA
Practice address
355 W Hickory Ave
Bastrop, LA 71220-4441
Phone
(318) 281-4450
Fax
(318) 281-4464
NPI assigned
Nov 28, 2005
Last updated
Jan 15, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 014889 LA Primary

Addresses

Primary practice location

355 W Hickory Ave
Bastrop, LA 71220-4441

Mailing address

130 Desiard St
Suite 355
Monroe, LA 71201-7319
Phone (318) 807-7875

Other identifiers 1

IdentifierTypeStateIssuer
1199346MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20080919000053 LA Practitioner - Family Practice 8729017280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in New Orleans, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sterlington Critical Access Hospital LLCGroup PAC ID 4486652385, shared by 6 NPIs, 12 clinicians

Practice addresses (Care Compare)

323 W Walnut Ave
Bastrop, LA 71220-4521
Phone (318) 614-0592

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014889LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sterlington Critical Access Hospital L.L.C CurrentSince May 1, 2017 Accepting new patients
Sterlington Critical Access Hospital L.L.C CurrentSince May 1, 2017 Accepting new patients
Sterlington Critical Access Hospital, L.L.C. CurrentSince May 1, 2017 Accepting new patients
Sterlington Critical Access Hospital, LLC Past Accepting new patients
Sterlington Critical Access Hospital, L.L.C. Past Accepting new patients

Locations

323 W Walnut Ave
Bastrop, LA 71220
Phone (318) 283-3600

355 W Hickory Ave
Bastrop, LA 71220
Phone (318) 281-4450

370 W Hickory Ave
Bastrop, LA 71220
Phone (318) 281-4531

370 W Hickory Ave
#B
Bastrop, LA 71220
Phone (318) 614-0592

220 Davenport Ave
Mer Rouge, LA 71261
Phone (318) 647-3420

10374 Highway 165 N
Ste D
Sterlington, LA 71280
Phone (318) 665-4543

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sterlington Rehabilitation HospitalBastrop, LA, CCN 193069 Hospital 5% Or Greater Indirect Ownership Interest
W-2 Managing Employee (12.5%)		 Nov 1, 2008
Jul 20, 2016
Sterlington Rural Health ClinicSterlington, LA, CCN 193473 Rural health clinic 5% Or Greater Direct Ownership Interest (12.5%) Mar 15, 2007
Sterlington Rehabilitation HospitalMer Rouge, LA, CCN 193486 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 1, 2007
Bastrop Outpatient Rural Health ClinicBastrop, LA, CCN 193484 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Director		 Mar 1, 2008
Mar 1, 2008

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 11

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": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1447233036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST",
            "address_2": "SUITE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017319",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W HICKORY AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204441",
            "telephone_number": "318-281-4450",
            "fax_number": "318-281-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBLE",
        "first_name": "JACK",
        "middle_name": "COLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "014889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1199346",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, LA

Sources for this page

Verify at the official NPI Registry.