Thomas Matthew Jacks, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D10665 Issued in OR

Practice address

2650 Suzanne Way Ste 110
Eugene, OR 97408-7619

Phone

(541) 726-4690

NPI assigned

Jan 20, 2006

Last updated

Feb 15, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 9, 2017 through Oct 9, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Gerald Alan Harper, DDS, PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Eugene, OR
  • NPI 1316243660

  Single Specialty

  NPD (past)
• Peacehealth

  dba Sacred Heart-RiverBend

  • General Acute Care Hospital
  • Springfield, OR
  • NPI 1083888515

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518652800000",
    "number": "1568442820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34362 DEERWOOD DR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974059662",
            "telephone_number": "301-943-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 SUZANNE WAY STE 110",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974087619",
            "telephone_number": "541-726-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "THOMAS",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2018-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D10665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "823753470",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Jolene Patricia Izsak
• Megan Izzo
• Jabeka Inc. (Franz Optical)
• Andrew Jablonski
• Jackie's Beauty Supply, LLC (The J Spa)
• Aloma Clee Jackson
• Anthony Lloyd Jackson
• Carolyn Jackson
• Corey Jai Jackson, M.A.
• Debra Lynn Jackson, PH.D.

• Oral and Maxillofacial Surgery (Dentist) in Eugene, OR
• Providers in Eugene, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.