Stanley K Jack, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

42877 Issued in CO

Practice address

2995 Baseline Rd Ste 200
Boulder, CO 80303-2318

Phone

(303) 440-8243

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 18, 2021 through Aug 18, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Flatirons Spine & Joint Health LLC

  • Medical Specialty Clinic/Center
  • Boulder, CO
  • NPI 1356096366
  NPD (past) Authorized official
• Flatirons Spine & Joint Health LLC

  • Medical Specialty Clinic/Center
  • Broomfield, CO
  • NPI 1790444669
  NPD (past) Authorized official
• Elk Ridge Family Physicians Inc

  • Family Medicine Physician
  • Evergreen, CO
  • NPI 1609832120
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1962578948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 BASELINE RD STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032318",
            "telephone_number": "303-440-8243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 BASELINE RD STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032318",
            "telephone_number": "303-440-8243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "STANLEY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "42877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J K Hullett Incorporated
• J.C. Sleeper, LLC
• Sakinah Jaaber, MA
• John S Jachimiak, DPM
• Mac Andrew Jack
• Cecilia Jackson
• David Paul Jackson, DDS
• Jennifer Jackson, MS, MFTC
• Stacy Marie Jackson, DDS
• Jessica Ann Jacobson, CF-SLP

• Family Medicine Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.