Active NPI
R Jack Eastham, MD
- Otolaryngology Physician
- Charlottesville, VA
National Provider Identifier
1477518389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 0101020554
- Practice address
- 1000 East High Street
Suite a
Charlottesville, VA 22902-4848 - Phone
- (434) 817-2300
- Fax
- (434) 817-2306
- NPI assigned
- Apr 20, 2006
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 0101020554 | VA | Primary |
Addresses
Primary practice location
1000 East High Street
Suite a
Charlottesville, VA 22902-4848
Mailing address
1000 East High Street
Suite a
Charlottesville, VA 22902-4848
Phone (434) 817-2300
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 419580 | Other | VA | SOUTHERN HEALTH |
| 6577725 | Medicaid | VA | |
| 014258 | Other | VA | ANTHEM BC BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101020554 | VA | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ears, Nose & Throat Consultants of Virginia, P.C. | Otolaryngology | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Specialist
- Charlottesville, VA
- NPI 1174614028
Otolaryngology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1477518389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 EAST HIGH STREET",
"address_2": "SUITE A",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229024848",
"telephone_number": "434-817-2300",
"fax_number": "434-817-2306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 EAST HIGH STREET",
"address_2": "SUITE A",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229024848",
"telephone_number": "434-817-2300",
"fax_number": "434-817-2306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EASTHAM",
"first_name": "R",
"middle_name": "JACK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "VA",
"license": "0101020554",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH",
"identifier": "419580",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6577725",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC BS",
"identifier": "014258",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.