Jack Osullivan, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0102207445 Issued in VA

Practice address

2080 Child St
Jacksonville, FL 32214-5005

Phone

(902) 542-7300

NPI assigned

May 25, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Family Practice

Education

Nova Southeastern College of Osteo Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SE Virginia Value Based Care LLCGroup PAC ID 6103288170, 160 clinicians

Mid-Atlantic Post Acute and Long Term Care PLLCGroup PAC ID 0648530782, 142 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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.

• Mid-Atlantic Post Acute & Long Term Care PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225557556
  Medicare reassignment Care Compare group NPD
• SE Virginia Value Based Care, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225720501
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1649845264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "902-542-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSULLIVAN",
        "first_name": "JACK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-25",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0102207445",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carmen E Osterhout, PT
• Taylor Elizabeth Osterhout
• Nathan Ostermann, DO
• Molly Ostrander
• Mary Elizabeth Ostroska, APRN
• Osvaldo Contarini MD PA
• Adam Oswald, DO
• Ashley Oswald, PA-C
• Craig J Oswald, DC
• Haley Oswald, PA-C

• General Practice Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.