Individual provider Active NPI

Matthew Jurcak, D.M.D.

  • Dentist
  • Jacksonville, FL
National Provider Identifier
1508240656
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30024538 Issued in OH
Practice address
2005 Knight Lane BLDG H Navy Medicine Support Command
Attn: Medical Staff SVCS
Jacksonville, FL 32212-0140
Phone
(760) 725-3213
NPI assigned
Jul 17, 2015
Last updated
Jul 17, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30024538 OH Primary

Addresses

Primary practice location

2005 Knight Lane BLDG H Navy Medicine Support Command
Attn: Medical Staff SVCS
Jacksonville, FL 32212-0140

Mailing address

Navy Medicine Support Command Attn: Medical Staff SVCS
BLDG H 2005 Knight Lane
Fpo, AA 32212-0140
Phone (760) 725-3213

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

State licenses

LicenseStateTypeSpecialty
30024538OHMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
United States Navy 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1508240656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS",
            "address_2": "BLDG H 2005 KNIGHT LANE",
            "city": "FPO",
            "state": "AA",
            "postal_code": "322120140",
            "telephone_number": "760-725-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 KNIGHT LANE BLDG H NAVY MEDICINE SUPPORT COMMAND",
            "address_2": "ATTN: MEDICAL STAFF SVCS",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322120140",
            "telephone_number": "760-725-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURCAK",
        "first_name": "MATTHEW",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30024538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.