NPIMap

Individual provider Active NPI

Alan Fowler Jacks, M. D.

  • Surgery Physician
  • Connelly Springs, NC
National Provider Identifier
1992987713
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
9601640 Issued in NC
Practice address
845 Malcolm Blvd.
Connelly Springs, NC 28612
Phone
(828) 580-3555
Fax
(828) 874-2111
NPI assigned
Dec 4, 2007
Last updated
May 23, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 9601640 NC Primary

Addresses

Primary practice location

845 Malcolm Blvd.
Connelly Springs, NC 28612

Mailing address

845 Malcolm Blvd.
Connelly Springs, NC 28612
Phone (828) 580-3555

Other identifiers 2

IdentifierTypeStateIssuer
1992987713MedicaidNC
891013EMedicaidNC

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
I20071224000024 NC Practitioner - General Surgery 1850481250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Louisiana State University School of Medicine in New Orleans, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

845 Malcolm Blvd
Connelly Springs, NC 28612-8615
Phone (828) 580-3555

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy14
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux11
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Healthcare Medical Group, Inc. Current Accepting new patients
Blue Ridge Healthcare Medical Group, Inc. CurrentSince Sep 1, 2014 Accepting new patients
Blue Ridge Healthcare Medical Group, Inc. Surgery CurrentSince Sep 1, 2014 Accepting new patients
Blue Ridge Healthcare Medical Group, Inc. Surgery Past Accepting new patients
Blue Ridge Healthcare Medical Group Inc Past Accepting new patients

Locations

2134 14th Avenue Cir NW
Ste D
Hickory, NC 28601
Phone (828) 580-1236

113 Foothills Dr
Ste A
Morganton, NC 28655
Phone (828) 580-4220

2201 S Sterling St
Morganton, NC 28655
Phone (828) 580-6393

Interoperability endpoints

  • Direct secure messaging: ajacks178240@direct.unc.nchie.net

Organizations & group practices 5

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 4

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": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527033600000",
    "number": "1992987713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 MALCOLM BLVD.",
            "city": "CONNELLY SPRINGS",
            "state": "NC",
            "postal_code": "28612",
            "telephone_number": "828-580-3555",
            "fax_number": "828-874-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 MALCOLM BLVD.",
            "city": "CONNELLY SPRINGS",
            "state": "NC",
            "postal_code": "28612",
            "telephone_number": "828-580-3555",
            "fax_number": "828-874-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "ALAN",
        "middle_name": "FOWLER",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-04",
        "last_updated": "2018-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "9601640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992987713",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891013E",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Connelly Springs, NC

Sources for this page

Verify at the official NPI Registry.