Jack Edward Runnels, DO

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

W8428 Issued in TX

Practice address

3133 Good Shepherd Way
Longview, TX 75605-7921

Phone

(903) 323-6500

Fax

(903) 315-4699

NPI assigned

Mar 30, 2022

Last updated

Sep 2, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Sports MedicineAlso: Family Practice

Education

Edward Via Col of Osteo Medicine-Carolinas Campus, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jrunnels3008192@carolinashealthcaresystem.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolinas Physicians Network Inc

  dba Atrium Health Musculoskeletal Institute Orthopedics & Sports Medici

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1437607686
  Medicare reassignment NPD
• Carolinas Physicians Network Inc

  dba The Sanger Clinic

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1477878890
  Medicare reassignment NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Musculoskeletal Institute Sports Medicine

  • Sports Medicine (Family Medicine) Physician
  • Concord, NC
  • NPI 1295967586
  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Musculoskeletal Institute Orthopedics & Sports Medici

  • Orthopaedic Surgery Physician
  • Albemarle, NC
  • NPI 1336543495
  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Diabetes Prevention

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1710627617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5651 POPLAR TENT RD STE 102",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280277686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3133 GOOD SHEPHERD WAY",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756057921",
            "telephone_number": "903-323-6500",
            "fax_number": "903-315-4699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5651 Poplar Tent Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280277686",
            "country_code": "US",
            "telephone_number": "704-782-4878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUNNELS",
        "first_name": "JACK",
        "middle_name": "EDWARD",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-30",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "W8428",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NC",
            "license": "2025-01850",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glen Royall
• Kelly Denise Royce, APRN, CNM
• Holly Kristina Royer, FNP-C
• Sarah Rudolph
• Kelly Marie Runk, LCDC
• Tina K Rushing, LCSW
• Debbie Russell
• Julia Ann Russell, FNP
• Trenton Russell
• Rustic Roots Family Care PLLC

• Sports Medicine (Family Medicine) Physician in Longview, TX
• Providers in Longview, TX by specialty
• Sports Medicine (Family Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; 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.