Michael Jack, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

36.003804 Issued in OH

Practice address

1930 State Route 59
Kent, OH 44240-4112

Phone

(330) 673-3505

Fax

(330) 673-4888

NPI assigned

Nov 18, 2014

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

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

United Podiatry IncGroup PAC ID 0143512046, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Summa Health System Hospital, Akron, OH, CCN 360020

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjack38006@ehrdirect.uhhospitals.org

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.

• United Podiatry Inc

  • Foot & Ankle Surgery Podiatrist
  • Kent, OH
  • NPI 1396106613
  Medicare reassignment Care Compare group NPD
• Hears LLC

  • Medical Specialty Clinic/Center
  • Akron, OH
  • NPI 1932943875
  NPD (past)

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

• Summa Health System

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Canton, OH
  • NPI 1295036762

  Hospital

  Care Compare affiliation
• Summa Health System

  • General Acute Care Hospital
  • Akron, OH
  • NPI 1396765681
  Care Compare affiliation
• Summa Health System

  • Clinical Medical Laboratory
  • Barberton, OH
  • NPI 1609263706

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1416268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1780080812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 STATE ROUTE 59",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442404112",
            "telephone_number": "330-596-6000",
            "fax_number": "330-596-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 STATE ROUTE 59",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442404112",
            "telephone_number": "330-673-3505",
            "fax_number": "330-673-4888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E State St",
            "address_2": "Medical Education-Podiatry Resident",
            "address_purpose": "LOCATION",
            "city": "Alliance",
            "state": "OH",
            "postal_code": "446014936",
            "country_code": "US",
            "telephone_number": "330-596-6000 x7750",
            "fax_number": "330-596-7752",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 5th St NE Ste 5",
            "address_purpose": "LOCATION",
            "city": "Barberton",
            "state": "OH",
            "postal_code": "442033017",
            "country_code": "US",
            "telephone_number": "330-864-8501",
            "fax_number": "330-864-8508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2950 W Market St",
            "address_purpose": "LOCATION",
            "city": "Fairlawn",
            "state": "OH",
            "postal_code": "443333614",
            "country_code": "US",
            "telephone_number": "330-864-8501",
            "fax_number": "330-864-8508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-18",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36.003804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Lynn Isackila, LPCC-S
• Christina A Isaman, O.D
• Theresa Italia
• Annatashia Iverson
• Mark Girish Jablonski, MD
• Antonio D. Jackson
• Deauveon Jackson
• Jaid Monique Jackson, LPN
• Sienna Jackson, LSW
• Vanessa Maria Jackson

• Podiatrist in Kent, OH
• Providers in Kent, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.