SAMANTHA JACK (NPI# 1316314925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316314925 |
| Entity Type | Individual |
| Full Name | SAMANTHA JACK |
| Credential | PA-C |
| Practice Address |
725 University Blvd Beavercreek OH 45324-2640 |
| Practice Telephone | 9372457150 |
| Mailing Telephone | 9372457150 |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2018-03-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
OH | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
725 UNIVERSITY BLVD |
| City | BEAVERCREEK |
| State | OH |
| Zip Code | 45324-2640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538794953 | Caleb Norton | Physical Therapist | 725 University Blvd, Beavercreek, OH 45324-2640 | 2020-03-05 |
| 1346707379 | Bryan Michael Dooley | Physician Assistant | 725 University Blvd, Beavercreek, OH 45324-2640 | 2019-02-26 |
| 1336627041 | Wade Stewart Rice | Physical Therapist | 725 University Blvd, Beavercreek, OH 45324 | 2018-08-03 |
| 1568955300 | Elizabeth Joan Usedom | Dermatology | 725 University Blvd, Beavercreek, OH 45324-2640 | 2018-06-06 |
| 1649768334 | Accelerated Rehabilitation Centers Ltd | Occupational Therapist | 725 University Blvd, Beavercreek, OH 45324-2640 | 2018-04-27 |
| 1174036008 | Brianna Lee Albers | Specialist/Technologist | 725 University Blvd, Beavercreek, OH 45324-2640 | 2017-11-14 |
| 1932628617 | Eric William Bornholdt | Specialist/Technologist | 725 University Blvd, Beavercreek, OH 45324-2640 | 2017-09-14 |
| 1174059109 | Patrick Veerkamp | Student in an Organized Health Care Education/Training Program | 725 University Blvd, Beavercreek, OH 45324-2640 | 2017-05-11 |
| 1063948438 | Clayton Douglas Conner | Student in an Organized Health Care Education/Training Program | 725 University Blvd, Beavercreek, OH 45324 | 2017-05-04 |
| 1801258397 | Keith Michael Reisinger-kindle | Obstetrics & Gynecology | 725 University Blvd, Beavercreek, OH 45324-2640 | 2016-03-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023647591 | Michael Hubbell | Student in an Organized Health Care Education/Training Program | 2555 University Blvd., Fairborn, OH 45324 | 2020-04-06 |
| 1982243382 | Wickshire Fairborn Opco LLC | Assisted Living Facility | 2270 Park Hills Drive, Fairborn, OH 45324 | 2020-01-02 |
| 1104301654 | Sophia Alridge | Counselor | 594 East Dayton Yellow Springs Road, Fairborn, OH 45324 | 2018-10-01 |
| 1750863189 | Sydney Bowser | Behavior Technician | 1750 Commerce Center Blvd., Fairborn, OH 45324 | 2018-09-01 |
| 1710406798 | Chester Cashmir Torkornoo | Dentist | 3989 Colonel Glenn Hwy A, Fairborn, OH 45324 | 2017-09-11 |
| 1245772375 | Ranada LLC | Health Maintenance Organization | 17 Vanderbilt Drive Apt G, Fairborn, OH 45324 | 2016-11-07 |
| 1194277582 | Derrick Bark | Specialist/Technologist | 85 Old Yellow Springs Rd, Fairborn, OH 45324 | 2016-11-01 |
| 1326592635 | Sheena Elizabeth Geoghegan | Student in an Organized Health Care Education/Training Program | 725 Univerisity Blvd., Wright State Physicians, Fairborn, OH 45324 | 2016-08-04 |
| 1912360199 | Tarah Heath | Occupational Therapist | 2498 Dayton, Beavercreek, OH 45324 | 2016-04-04 |
| 1255706339 | Cierra Jackson | Counselor | 1560 Calder Ct, Fairborn, OH 45324 | 2015-12-01 |
| Find all providers in zip 45324 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861631145 | Jill O'connor | Physician Assistant | 2587 Commons Blvd, Suite 110, Beavercreek, OH 45431-3841 | 2009-02-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508418260 | Collin Dees | Physician Assistant | Tripoint Medical Center, 7590 Auburn Road, Painesville, OH 44077 | 2019-07-12 |
| 1811469968 | Cody Tyler Delaney | Physician Assistant | 1711 27th St Ste 306, Portsmouth, OH 45662-2669 | 2018-12-28 |
| 1861936155 | Surgical Fusion, LLC | Physician Assistant | 605 N High St # 237, Columbus, OH 43215-2024 | 2016-12-06 |
| 1225481690 | Rebekah Keesee | Physician Assistant | 1045 Arundel Ave, Westerville, OH 43081-1188 | 2016-07-20 |
| 1568814382 | Kristen Cipolla | Physician Assistant | 1049 Scarlet Oak Dr Apt D, Hudson, OH 44236-4542 | 2016-07-05 |
| 1932560083 | Adam Peckinpaugh | Physician Assistant | 2109 Hughes Drive #450, Jobst Vascular Institute, Toledo, OH 43606-5102 | 2016-03-17 |
| 1710348701 | Alex Blake | Physician Assistant | 10743 S State Route 133, Blanchester, OH 45107-9435 | 2016-03-17 |
| 1215319926 | Richard Alan Stevenson | Physician Assistant | 187 Vine St, Fairborn, OH 45324-3324 | 2015-06-18 |
| 1548641038 | Matthew Hamley | Physician Assistant | 2315 Birch Trace Dr, Youngstown, OH 44515-4914 | 2015-06-10 |
| 1588094148 | Kevin W. Rotondo | Physician Assistant | 1732 Maple St, Wickliffe, OH 44092-2423 | 2013-11-19 |
| Find all providers with the same taxonomy | ||||
| City | BEAVERCREEK |
| Zip Code | 45324 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.