NPIMap

Individual provider Active NPI

Dennis Michael Jack, FNP

  • Family Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1659858827
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
343352 Issued in NY
Practice address
462 Grider St
Buffalo, NY 14215-3021
Phone
(716) 609-0312
NPI assigned
Jul 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 343352 NY Primary

Addresses

Primary practice location

462 Grider St
Buffalo, NY 14215-3021

Mailing address

6103 Woodford Dr
Lake View, NY 14085-9457
Phone (716) 609-0312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180820001666 NY Practitioner - Nurse Practitioner 3678822939 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Erie County Medical Center CorporationGroup PAC ID 1456308907, 316 clinicians

Practice addresses (Care Compare)

462 Grider St
Buffalo, NY 14215-3021
Phone (716) 898-3000

Hospital & facility affiliations

  • Erie County Medical Center Hospital, Buffalo, NY, CCN 330219
  • Rochester General Hospital Hospital, Rochester, NY, CCN 330125
  • Brooks-TLC Hospital System, Inc Hospital, Dunkirk, NY, CCN 330229
  • Kaleida Health Hospital, Buffalo, NY, CCN 330005
  • Sisters of Charity Hospital Hospital, Buffalo, NY, CCN 330078

Merit-based Incentive Payment System (MIPS)

Final score
90.97 of 100Reported as group
Quality
80.2
Improvement activities
40
Cost
72.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
343352NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Buffalo Medical Group, P.C. Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Sep 1, 2023 Accepting new patients
Academic Medicine Services, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Erie County Medical Center Corporation CurrentSince Jun 22, 2021 Accepting new patients
Ub Family Medicine, Inc Family Medicine Current Accepting new patients
Erie County Medical Center Corporation CurrentSince Jun 22, 2021 Accepting new patients

Locations

462 Grider St
Fl 11
Buffalo, NY 14215
Phone (716) 898-4803

85 High St
Buffalo, NY 14203
Phone (716) 857-8623

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

4498 Main St
Ste 23
Buffalo, NY 14226

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

Interoperability endpoints

  • Direct secure messaging: dennisjack@ubmd.allscriptsdirect.net

Organizations & group practices 6

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1659858827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6103 WOODFORD DR",
            "city": "LAKE VIEW",
            "state": "NY",
            "postal_code": "140859457",
            "telephone_number": "716-609-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-609-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "DENNIS",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-20",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "343352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.