Jack C. Scott, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

21065 Issued in MN

Practice address

7205 University Ave NE
Fridley, MN 55432-3134

Phone

(763) 571-4000

Fax

(763) 571-7202

NPI assigned

Jun 22, 2006

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Associated Skin Care Specialists, PA

  • Dermatology Physician
  • Coon Rapids, MN
  • NPI 1083659569

  Specialist

  NPD

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619913050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323134",
            "telephone_number": "763-571-4000",
            "fax_number": "763-571-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7205 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323134",
            "telephone_number": "763-571-4000",
            "fax_number": "763-571-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "JACK",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "21065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870787100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Schroepfer
• Samantha Jo Schultz, CNP
• Carla Ann Schwartz, M.D.
• Emma Schoen Schwartz, DPT
• Christiane Schwecke, ATC
• Natalie Sears
• Corinne Segal, LPCC
• Nickolas Sell, PHARMD
• Kathryn Kim Selmo, MD
• Betlehem Semahge, M.D.

• Specialist in Fridley, MN
• Providers in Fridley, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.