Jack L Forest, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

049972 Issued in VA

Practice address

2016 S Main St
Maryville, MO 64468-2655

Phone

(660) 562-2600

Fax

(660) 562-7911

NPI assigned

Oct 4, 2005

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 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

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.

• Vohra Post Acute Care Physicians of Texas, PLLC

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1821424789

  TX

  Medicare reassignment Care Compare group NPD
• Fannin County Hospital Authority

  • Critical Access Hospital
  • Bonham, TX
  • NPI 1851408561

  TX

  Medicare reassignment NPD
• Commonwealth General Surgery

  • Surgery Physician
  • South Hill, VA
  • NPI 1093809352

  Surgery

  NPD (past) Authorized official
• Fannin County Hospital Authority

  • Skilled Nursing Facility
  • Rockdale, TX
  • NPI 1346904281
  NPD
• Fannin County Hospital Authority

  • Anesthesiology Physician
  • Bonham, TX
  • NPI 1689272932
  NPD
• Fannin County Hospital Authority

  • Critical Access Hospital
  • Bonham, TX
  • NPI 1699705301
  NPD
• Fannin County Hospital Authority

  • Critical Access Hospital
  • Bonham, TX
  • NPI 1760417646
  NPD
• Bon Secours St Francis Medical Center LLC

  • Surgery Physician
  • Midlothian, VA
  • NPI 1083841936

  Surgery

  NPD (past)
• Bon Secours St. Francis Medical Center Inc

  • Neurology Physician
  • Chester, VA
  • NPI 1811228711
  NPD (past)
• Bon Secours St. Francis Medical Center LLC

  • Internal Medicine Physician
  • Midlothian, VA
  • NPI 1053698399
  NPD (past)
• Fannin County Hospital Authority

  • Pain Medicine (Anesthesiology) Physician
  • Bonham, TX
  • NPI 1437486867
  NPD (past)
• Fannin County Hospital Authority

  • Skilled Nursing Facility
  • Athens, TX
  • NPI 1447244116
  NPD (past)

Specialty

General Surgery

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Vohra Post Acute Care Physicians of Texas, PLLC 41 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1679560775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 E SOUTH HILLS DR",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682659",
            "telephone_number": "660-562-2600",
            "fax_number": "660-562-7911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682655",
            "telephone_number": "660-562-2600",
            "fax_number": "660-562-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOREST",
        "first_name": "JACK",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "049972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C09633",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7313519",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06695",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Michael Feuerbacher, M.D.
• Charles S Fillingane II, DO
• Lisa Finney, FNP-C
• Dallas Dustin Fitzgerald, O.D.
• Miranda Marie Floyd, AGACNP
• Joshua Wayne Foster, DO
• Fox Ridge Wellness & Rehabilitation LLC
• David A Fox II, M.D.
• Kyle Jordan Frerking, LAT, ATC
• Karen E. From, RDN

• All providers in Maryville, MO
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; 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.