Active NPI
Elizabeth Anne Jack, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Carson City, NV
National Provider Identifier
1538230545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 5089
- Practice address
- 1600 Medical Pkwy
Carson City, NV 89703-4625 - Phone
- (775) 445-8502
- Fax
- (775) 888-4448
- NPI assigned
- Nov 13, 2006
- Last updated
- Dec 18, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 5089 | NV | Primary |
Addresses
Primary practice location
1600 Medical Pkwy
Carson City, NV 89703-4625
Mailing address
PO Box 21609
Carson City, NV 89721-1609
Phone (775) 884-2455
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538230545 | Medicaid | NV |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Basin Imaging | Past | Accepting new patients | |
| Tahoe Carson Radiology Loos Et Al LTD | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Clinical Medical Laboratory
- Carson City, NV
- NPI 1104971183
-
- Diagnostic Radiology Physician
- Carson City, NV
- NPI 1093747446
-
dba Tahoe Carson Radiology
- Diagnostic Radiology Physician
- Carson City, NV
- NPI 1902838352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545091200000",
"number": "1538230545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 21609",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "897211609",
"telephone_number": "775-884-2455",
"fax_number": "775-884-0345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 MEDICAL PKWY",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "897034625",
"telephone_number": "775-445-8502",
"fax_number": "775-888-4448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "ELIZABETH",
"middle_name": "ANNE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2018-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NV",
"license": "5089",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1538230545",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carson City, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.