Individual provider Active NPI

Jack D Scott, MD

  • Emergency Medicine Physician
  • Gainesville, FL
National Provider Identifier
1629056189
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME69637 Issued in FL
Practice address
1600 SW Archer Rd
Gainesville, FL 32610-3003
Phone
(352) 265-5911
Fax
(352) 265-5606
NPI assigned
Jan 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01072522A IN
Emergency Medicine Physician 207P00000X ME69637 FL Primary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 01072522A IN
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X ME0069637 FL

Addresses

Primary practice location

1600 SW Archer Rd
Gainesville, FL 32610-3003

Mailing address

PO Box 918025
Orlando, FL 32891-8025
Phone (352) 265-5911

Other practice location 1

PO Box 635004
Cincinnati, OH 45263-5004
Phone (260) 435-2699

Other practice location 2

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 435-2699

Other identifiers 4

IdentifierTypeStateIssuer
0913926MedicaidOH
250686600MedicaidFL
P00162734OtherFLRRMCR
28263OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20130809000631 IN Practitioner - Emergency Medicine 6608856786 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME69637FLMDEmergency Medicine Physician
ME0069637FLMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Professionals of Indiana, P.C. Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
Nes of Florida Inc Emergency Medicine Past Accepting new patients
Ohio Em-I Medical Services, Professional Association Past Accepting new patients
Emergency Physicians Inc Emergency Medicine Past Accepting new patients
Emergency Medicine of Indiana LLC Emergency Medicine Past Accepting new patients
Lakeland Regional Medical Center, Inc. Past Accepting new patients
Nes of Florida Inc Emergency Medicine Past Accepting new patients
Dolphin Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Magnolia Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Florida Em-I Medical Services PA Emergency Medicine Past Accepting new patients
Osprey Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Shands at Lake Shore Inc Past Accepting new patients
Shands Teaching Hospital and Clinics Inc Past Accepting new patients
Shands Teaching Hospital and Clinics Inc Past Accepting new patients
Nes of Northern Florida Inc Emergency Medicine Past Accepting new patients
Florida Em-I Medical Services PA Emergency Medicine Past Accepting new patients
Oakfield Drive Emergency Physicians LLC Emergency Medicine Past Accepting new patients

Locations

303 S Main St
Bluffton, IN 46714
Phone (260) 824-0800

3700 Washington Ave
Evansville, IN 47714
Phone (812) 232-0021

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

2520 E DuPont Rd
Fort Wayne, IN 46825
Phone (219) 407-8000

702 Van Buren St
Fort Wayne, IN 46802
Phone (260) 425-3000

85 E US Highway 6
Valparaiso, IN 46383
Phone (219) 983-5743

2101 Dubois Dr
Warsaw, IN 46580
Phone (219) 267-3200

Organizations & group practices 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1629056189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 918025",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328918025",
            "telephone_number": "352-265-5911",
            "fax_number": "352-265-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-265-5911",
            "fax_number": "352-265-5606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "PO Box 635004",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452635004",
            "country_code": "US",
            "telephone_number": "260-435-2699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7950 W Jefferson Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468044140",
            "country_code": "US",
            "telephone_number": "260-435-2699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "JACK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01072522A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME69637",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IN",
            "license": "01072522A",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "FL",
            "license": "ME0069637",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0913926",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250686600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR",
            "identifier": "P00162734",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "28263",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.