Jack Havdala, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

E3961 Issued in AR

Practice address

201 E Oak Ave
Jonesboro, AR 72401

Phone

(870) 935-6729

Fax

(870) 268-4408

NPI assigned

Jun 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General SurgeryAlso: Cardiac Surgery, Thoracic Surgery, Vascular Surgery

Education

R Franklin University of Med & Sci/Chicago Medical School, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Bernards Physician Clinics IncGroup PAC ID 7012311269, 211 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Bernards Medical Center Hospital, Jonesboro, AR, CCN 040020
• Arkansas Methodist Medical Center Hospital, Paragould, AR, CCN 040039

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jhavdala@sbpc.medalliesdirect.net

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.

• St Bernards Physician Clinics Inc

  • Surgery Physician
  • Jonesboro, AR
  • NPI 1447923438
  Medicare reassignment Care Compare group NPD
• St Bernards Physician Clinics Inc

  • Primary Care Clinic/Center
  • Jonesboro, AR
  • NPI 1275204307
  NPD
• St Bernards Physician Clinics Inc

  • Diagnostic Radiology Physician
  • Jonesboro, AR
  • NPI 1780546051
  NPD
• Cardiothoracic Surgery Group SC

  • Vascular Surgery Physician
  • Milwaukee, WI
  • NPI 1053388553
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Arkansas Methodist Hospital Corporation

  • General Acute Care Hospital
  • Paragould, AR
  • NPI 1437222312
  Care Compare affiliation
• St Bernards Hospital Inc

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1922043686
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1477558955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E OAK AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-935-6729",
            "fax_number": "870-268-4408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E OAK AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-935-6729",
            "fax_number": "870-268-4408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVDALA",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AR",
            "license": "E3961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "E3961",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32638100",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Hathcock, PA-C
• Aaron E Hattle
• Corey Haughey, D.D.S.
• Michael Allen Haughey, D.P.M.
• Matthew M. Haustein, MD
• Haven Chiropractic PLLC
• Amer Yacoub Salem Hawatmeh, MD
• Brooke Erin Hawkins, MCD, CF-SLP
• Hailey Suzanne Hawkins
• Maceo Hawkins

• Vascular Surgery Physician in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Vascular Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.