NPIMap

Individual provider Active NPI

Jonathan Juturu Jack, MD

  • Internal Medicine Physician
  • Roanoke Rapids, NC
National Provider Identifier
1730250267
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9701417 Issued in NC
Practice address
270 Smith Church Road
Roanoke Rapids, NC 27870
Phone
(252) 537-0134
Fax
(252) 537-6515
NPI assigned
Nov 13, 2006
Last updated
Jul 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9701417 NC Primary

Addresses

Primary practice location

270 Smith Church Road
Roanoke Rapids, NC 27870

Mailing address

PO Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100331001063 NC Practitioner - Internal Medicine 1759417470 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Group IncGroup PAC ID 9739090226, shared by 19 NPIs, 65 clinicians

Practice addresses (Care Compare)

1096 E 10TH St
Roanoke Rapids, NC 27870-3052
Phone (252) 535-3516

250 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone (252) 308-9699

270 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone (252) 537-0134

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9701417NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. CurrentSince Jul 25, 2018 Accepting new patients
Rural Health Group, Inc. CurrentSince Jul 25, 2018 Accepting new patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. CurrentSince Dec 5, 2023 Accepting new patients
Rural Health Group Inc CurrentSince Dec 5, 2023 Accepting new patients

Locations

1096 E 10th St
Roanoke Rapids, NC 27870
Phone (252) 535-3516

1381 Medical Center Dr
Roanoke Rapids, NC 27870
Phone (252) 535-1414

2066 NC Highway 125
Roanoke Rapids, NC 27870
Phone (252) 536-5000

250 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-9699

270 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-6816

Interoperability endpoints

  • Direct secure messaging: jonathan.jack@rhgnc.eclinicaldirectplus.com

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1730250267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278700640",
            "telephone_number": "252-536-5440",
            "fax_number": "252-536-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 SMITH CHURCH ROAD",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "27870",
            "telephone_number": "252-537-0134",
            "fax_number": "252-537-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "JONATHAN",
        "middle_name": "JUTURU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9701417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke Rapids, NC

Sources for this page

Verify at the official NPI Registry.