Jack Russelle Lake, DO - Medicare Diagnostic Radiology in Albany, GA

  1. Home
  2. Radiology
  3. GA
  4. Albany
Jack Russelle Lake, DO is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Albany, Georgia. He graduated from medical school in 2003 and has 22 years of diverse experience with area of expertise as Diagnostic Radiology. He is a member of the group practice Pro Radiology Llc, North Star Fm Lp, North Star Mcd Llc, Synergy Radiology Llc, North Star Mri Of Frisco Lp, North Star Mri Lp and his current practice location is 2624 Dawson Rd, Albany, Georgia. You can reach out to his office (for appointments etc.) via phone at (229) 888-1624.

Jack Russelle Lake is licensed to practice in Oklahoma (license number 4205) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1932248101.

Contact Information

Jack Russelle Lake, DO
2624 Dawson Rd,
Albany, GA 31707-1609
(229) 888-1624
Not Available

Map and Direction




Physician's Profile

Full NameJack Russelle Lake
GenderMale
SpecialityDiagnostic Radiology
Experience22 Years
Location2624 Dawson Rd, Albany, Georgia
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Jack Russelle Lake graduated from medical school in 2003
  NPI Data:
  • NPI Number: 1932248101
  • Provider Enumeration Date: 02/05/2007
  • Last Update Date: 10/30/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 0648323840
  • Enrollment ID: I20090805000816

Medical Identifiers

Medical identifiers for Jack Russelle Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1932248101NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085R0202XRadiology - Diagnostic Radiology 101304 (Georgia)Secondary
2085R0202XRadiology - Diagnostic Radiology 4205 (Oklahoma)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Pro Radiology Llc105269643282
North Star Fm Lp115359176353
North Star Mcd Llc266865943467
Synergy Radiology Llc266872774478
North Star Mri Of Frisco Lp276957485443
North Star Mri Lp589076233053

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jack Russelle Lake allows following entities to bill medicare on his behalf.
Entity NameNorman Radiology Services, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1326039645
PECOS PAC ID: 2466496641
Enrollment ID: O20050617000884
Entity NameNorth Star Cn Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1013305945
PECOS PAC ID: 0547589376
Enrollment ID: O20210720000562
Entity NameNorth Star Diagnostic Imaging Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1467787739
PECOS PAC ID: 8729118021
Enrollment ID: O20210820001083
Entity NameNorth Star Npt Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1699387647
PECOS PAC ID: 8426468265
Enrollment ID: O20210910001803
Entity NameNorth Star Fm Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1174812028
PECOS PAC ID: 1153591763
Enrollment ID: O20210914001344
Entity NameNorth Star Fp Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033630835
PECOS PAC ID: 6800168576
Enrollment ID: O20211102002362
Entity NameNorth Star Gv Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1922512664
PECOS PAC ID: 0648539023
Enrollment ID: O20220106001418
Entity NameNorth Star Mcd Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1700550282
PECOS PAC ID: 2668659434
Enrollment ID: O20220209002627
Entity NameNorth Star Mri Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033174701
PECOS PAC ID: 5890762330
Enrollment ID: O20220209002860
Entity NameNorth Star Mri Of Frisco Lp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1649356759
PECOS PAC ID: 2769574854
Enrollment ID: O20220221001718
Entity NameSynergy Radiology Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1588229918
PECOS PAC ID: 2668727744
Enrollment ID: O20241015004224
Entity NamePro Radiology, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1942733308
PECOS PAC ID: 1052696432
Enrollment ID: O20250401000652

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack Russelle Lake is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jack Russelle Lake, DO
700 E Morehead St Ste 300,
Charlotte, NC 28202-2742

Ph: () -		Jack Russelle Lake, DO
2624 Dawson Rd,
Albany, GA 31707-1609

Ph: (229) 888-1624

Reviews and Comments


Radiology Doctors in Albany, GA

Dr. Allison Lea Hays, MD
Radiology
Medicare: Medicare Enrolled
Practice Location: 417 W 3rd Ave, Albany, GA 31701
Phone: 706-653-1088    Fax: 706-653-1162
Suresh K Lakhanpal, MD
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 417 W 3rd Ave, Albany, GA 31701
Phone: 706-653-1088    Fax: 706-653-1162
Edwin J Fortenbery, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 417 W 3rd Ave, Albany, GA 31701
Phone: 706-653-1088    Fax: 706-653-1162
Frank Maynard Thames Jr., M.D.
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 2219 Golf Course Dr, Albany, GA 31721
Phone: 229-435-2964    
Robert Lewis Stickle, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 2624 Dawson Rd, Albany, GA 31707
Phone: 229-888-1624    
Dr. Nicholas Mark Gutierrez, M.D.
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 2624 Dawson Rd, Albany, GA 31707
Phone: 229-888-1624    
William Joel Mcafee, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 425 W 3rd Ave Ste 50, Albany, GA 31701
Phone: 229-883-0717    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.