GREGORY SCOTT JACK (NPI# 1447503826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447503826 |
| Entity Type | Individual |
| Full Name | GREGORY SCOTT JACK |
| Credential | M.D. |
| Practice Address |
1260 15th St 1200 Santa Monica CA 90404-1135 |
| Mailing Address |
200 Medical Plz 140 Los Angeles CA 90095-0001 |
| Practice Telephone | 3107947700 |
| Practice Fax Number | 3109395302 |
| Mailing Telephone | 3108251172 |
| Mailing Fax Number | 3107940987 |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2013-01-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | A83253 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1447503826 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164517512 | Gregory Bruce Jack | Counselor | 50 Academy Hill Road, Plainfield, CT 06374 | 2006-10-03 |
| Street Address |
1260 15TH ST 1200 |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 90404-1135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497748818 | Swiss Balance Inc | Prosthetic/Orthotic Supplier | 1260 15th St, Ste 1402, Santa Monica, CA 90404-1135 | 2005-08-31 |
| 1609249408 | Regents of The University of California | Urology | 1260 15th St, Suite 1200, Santa Monica, CA 90404-1135 | 2015-11-03 |
| 1447646682 | Safina Aulakh | Naturopath | 1260 15th St, Suite 1101, Santa Monica, CA 90404-1135 | 2015-04-14 |
| 1891053559 | Regents of The Univ of California | Durable Medical Equipment & Medical Supplies | 1260 15th St, Suite 900, Santa Monica, CA 90404-1135 | 2012-05-01 |
| 1124385059 | Daniel L. Altchuler, Dpm, Podiatry Corporation | Non-Pharmacy Dispensing Site | 1260 15th St, Suite 1020, Santa Monica, CA 90404-1135 | 2012-04-17 |
| 1770856528 | Edmond Ahdoot | Dentist | 1260 15th St, Suite 805, Santa Monica, CA 90404-1135 | 2012-02-09 |
| 1548532344 | Sarah Frances D'ambruoso | Registered Nurse | 1260 15th St, Santa Monica, CA 90404-1135 | 2012-02-08 |
| 1477824175 | Paul Carlo | Social Worker | 1260 15th St, Ste 920, Santa Monica, CA 90404 | 2012-01-26 |
| 1619248184 | Stacey C Carter | Urology | 1260 15th St, Suite 1200, Santa Monica, CA 90404-1135 | 2012-01-15 |
| 1639478050 | The Regents of The University of California | Durable Medical Equipment & Medical Supplies | 1260 15th St, Suite 900, Santa Monica, CA 90404-1135 | 2011-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306453352 | Jasmine Burton | Physical Therapist | 1714 17th Street, Santa Monica, CA 90404 | 2020-09-24 |
| 1003431685 | Cintia Haydee Ctibor | Behavior Technician | 1869 9th Street, Santa Monica, CA 90404 | 2020-06-10 |
| 1073137261 | Sydney Kristine Valerio | Counselor | 1869 9th St, Santa Monica, CA 90404 | 2020-06-03 |
| 1710507082 | James Gilbert Cunningham | Marriage & Family Therapist | 1708 Olympic Blvd, Santa Monica, CA 90404 | 2020-04-16 |
| 1841763687 | Crystal Monique Mckinley X | Counselor | 1865 9th St, Santa Monica, CA 90404 | 2019-01-04 |
| 1952872749 | Cesar O Munoz | Licensed Vocational Nurse | 1865 9th St., Santa Monica, CA 90404 | 2018-12-06 |
| 1023596574 | Joseph J Pinzone Md Inc | Internal Medicine | 2001 Santa Monica Blvd Ste 1190, Santa Monica, CA 90404 | 2018-08-06 |
| 1548763535 | Alan Rubenstein Dds Inc | Dentist | 1260 15th St., #703, Santa Monica, CA 90404 | 2018-03-15 |
| 1669993382 | Aaron Wilson | Counselor | 1453 16th Street, Santa Monica, CA 90404 | 2017-07-03 |
| 1922472471 | Chianni Lin | Acupuncturist | 2222 Santa Monica Blvd, Ste. 105, Santa Monica, CA 90404 | 2015-11-20 |
| Find all providers in zip 90404 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154518629 | Mehran Movassaghi | Urology | 2001 Santa Monica Blvd Ste 460w, Santa Monica, CA 90404-2178 | 2007-09-28 |
| 1336181965 | Karyn S Eilber | Urology | 2020 Santa Monica Blvd., Suite 570, Santa Monica, CA 90404 | 2006-06-11 |
| 1912996851 | Martin K. Gelbard | Urology | 1260 15th St Ste 1200, Santa Monica, CA 90404-1147 | 2005-10-13 |
| 1922487800 | Jeannie Jiwon Su | Urology | 2121 Santa Monica Blvd, Santa Monica, CA 90404-2303 | 2015-05-25 |
| 1740628866 | Stanley Brosman Medical Corporation | Urology | 2021 Santa Monica Blvd, Suite 510, Santa Monica, CA 90404-2219 | 2013-06-11 |
| 1619248184 | Stacey C Carter | Urology | 1260 15th St, Suite 1200, Santa Monica, CA 90404-1135 | 2012-01-15 |
| 1770773269 | Dino T. Deconcini Md Inc | Urology | 2021 Santa Monica Blvd, 510 E, Santa Monica, CA 90404-2160 | 2007-07-31 |
| 1881891042 | Jennifer A Linehan | Urology | 2121 Santa Monica Blvd, Santa Monica, CA 90404-2303 | 2007-06-29 |
| 1538371679 | Zachery Chad Baxter | Urology | 1260 15th St Ste 1200, Santa Monica, CA 90404 | 2007-05-03 |
| 1295881803 | Jesse N Mills | Urology | 1260 15th St, Suite 1200, Santa Monica, CA 90404-1135 | 2007-01-26 |
| Find all providers in SANTA MONICA | ||||
| City | SANTA MONICA |
| Zip Code | 90404 |
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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.