Mrs Samara Ja'nel Jack, PA-C - Medicare Physician Assistant in Tulsa, OK

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Mrs Samara Ja'nel Jack, PA-C is a medicare enrolled "Physician Assistant" in Tulsa, Oklahoma. Her current practice location is 7858 S Olympia Ave, Tulsa, Oklahoma. You can reach out to her office (for appointments etc.) via phone at (918) 986-9200.

Mrs Samara Ja'nel Jack is licensed to practice in Oklahoma (license number 1919) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1245550433.

Contact Information

Mrs Samara Ja'nel Jack, PA-C
7858 S Olympia Ave,
Tulsa, OK 74132-1857
(918) 986-9200
(918) 986-9205

Map and Direction




Provider's Profile

Full NameMrs Samara Ja'nel Jack
GenderFemale
SpecialityPhysician Assistant
Location7858 S Olympia Ave, Tulsa, Oklahoma
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1245550433
  • Provider Enumeration Date: 06/10/2010
  • Last Update Date: 02/28/2019
  Medicare PECOS Information:
  • PECOS PAC ID: 6103015086
  • Enrollment ID: I20110107000198

Medical Identifiers

Medical identifiers for Mrs Samara Ja'nel Jack such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1245550433NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 1919 (Oklahoma)Primary

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. Mrs Samara Ja'nel Jack allows following entities to bill medicare on her behalf.
Entity NameSt. John Physicians, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1336194406
PECOS PAC ID: 2567366495
Enrollment ID: O20031121000867
Entity NameOmni Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1174578249
PECOS PAC ID: 9739080490
Enrollment ID: O20040115000897
Entity NameSt John Urgent Care Clinics Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1003918830
PECOS PAC ID: 5890898084
Enrollment ID: O20070308000190
Entity NameTulsa Hospital Medicine Physicians Group, LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1144982711
PECOS PAC ID: 7214327832
Enrollment ID: O20211214000389

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. Mrs Samara Ja'nel Jack 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
Mrs Samara Ja'nel Jack, PA-C
1705 E 19th St Ste 302,
Tulsa, OK 74104-5410

Ph: (918) 748-7585		Mrs Samara Ja'nel Jack, PA-C
7858 S Olympia Ave,
Tulsa, OK 74132-1857

Ph: (918) 986-9200

Reviews and Comments


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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.