NPIMap

Individual provider Active NPI

Timothy Jack, MD

  • Psychiatry Physician
  • Baltimore, MD
National Provider Identifier
1891949723
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
D0032712 Issued in MD
Practice address
1040 Park Ave Ste 200
Baltimore, MD 21201-5634
Phone
(443) 738-0300
Fax
(443) 738-0301
NPI assigned
Nov 5, 2008
Last updated
Oct 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X D0032712 MD Primary

Addresses

Primary practice location

1040 Park Ave Ste 200
Baltimore, MD 21201-5634

Mailing address

1040 Park Ave Ste 200
Baltimore, MD 21201-5634
Phone (443) 738-0300

Other identifiers 1

IdentifierTypeStateIssuer
062131500MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MD, FL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20150527000002 CA Practitioner - Psychiatry 1658691027 Reassigns benefits to 1 organization
I20240417003453 MD Practitioner - Psychiatry 1658691027 Reassigns benefits to 1 organization
I20260326001807 FL Practitioner - Psychiatry 1658691027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Maryland School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Community Health Centers IncGroup PAC ID 9931017126, shared by 15 NPIs, 32 clinicians

Practice addresses (Care Compare)

315 S W C Owen Ave
Clewiston, FL 33440-3637
Phone (863) 983-7813

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0032712MDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crossroads Behavioral Health Center CurrentSince Aug 3, 2025 Accepting new patients
Baltimore Medical System, Inc. CurrentSince May 11, 2024 Accepting new patients
Step Up on Second Street Inc. CurrentSince Mar 3, 2015 Accepting new patients
Jackson Professional Associates LLC Psychiatry CurrentSince Aug 20, 2026 Accepting new patients
Mindoula Health Inc. CurrentSince Sep 16, 2020 Accepting new patients
Step Up on Second Street, Inc. CurrentSince Mar 3, 2015 Accepting new patients
Baltimore Medical System, Inc. CurrentSince May 11, 2024 Accepting new patients
Step Up on Second Street, Inc. Current Accepting new patients
MCS, PC Psychiatry Past Accepting new patients
County of Alameda Past Accepting new patients

Locations

501 W Broadway
Ste 800
San Diego, CA 92101
Phone (619) 400-4943

210 Russell St
Creston, IA 50801
Phone (641) 782-8457

405 E McLane St
Osceola, IA 50213
Phone (641) 342-4888

1040 Park Ave
Ste 200
Baltimore, MD 21201
Phone (443) 738-0300

1000 Stewart Ave
Glen Burnie, MD 21061

1117 E West Hwy
Silver Spring, MD 20910
Phone 202360478714

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1891949723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 PARK AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015634",
            "telephone_number": "443-738-0300",
            "fax_number": "443-738-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 PARK AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015634",
            "telephone_number": "443-738-0300",
            "fax_number": "443-738-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-05",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0032712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062131500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.