Dr Charles Jack, PHD in Hamburg, NY - Medicare Psychologist Provider

Dr Charles Jack, PHD is a medicare enrolled "Psychologist - Clinical" provider in Hamburg, New York. His current practice location is 5178 Parker Rd, Hamburg, New York. You can reach out to his office (for appointments etc.) via phone at (716) 598-8827.

Dr Charles Jack is licensed to practice in New Jersey (license number 35SI00726500) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1376201772.

Contact Information

	Dr Charles Jack, PHD
	5178 Parker Rd, Hamburg, NY 14075
	(716) 598-8827
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Charles Jack
Gender	Male
Speciality	Psychologist - Clinical
Location	5178 Parker Rd, Hamburg, New York
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1376201772
Provider Enumeration Date: 12/02/2021
Last Update Date: 11/24/2023

Medicare PECOS Information:

PECOS PAC ID: 2769830306
Enrollment ID: I20231121001029

Medical Identifiers

Medical identifiers for Dr Charles Jack such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1376201772	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	(* (Not Available))	Secondary
103TC0700X	Psychologist - Clinical	35SI00726500 (New Jersey)	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. Dr Charles Jack allows following entities to bill medicare on his behalf.

Entity Name	Senior Care Therapy Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1285898098 PECOS PAC ID: 0547335366 Enrollment ID: O20080813000563

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. Dr Charles 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 Address	Practice Location Address
Dr Charles Jack, PHD 5178 Parker Rd, Hamburg, NY 14075 Ph: (716) 598-8827	Dr Charles Jack, PHD 5178 Parker Rd, Hamburg, NY 14075 Ph: (716) 598-8827

Reviews and Comments

Psychologist in Hamburg, NY

Ms. Amanda Rene Desio Whitehouse, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 5949 Camp Rd #1164, Hamburg, NY 14075 Phone: 716-249-0500 Fax: 716-427-2782
Dr. Kelly Coleman, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 162 Main St, Hamburg, NY 14075 Phone: 716-371-1995
Dr. Kimberly Franklin, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 84 Lake St., Hamburg, NY 14075 Phone: 716-422-0054
Dr. Robert S Zam, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 46 Main Street, Hamburg, NY 14075 Phone: 716-646-4991 Fax: 716-646-4991
Dr. Michelle Leigh Chaffee, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 150 Pleasant Ave, Hamburg, NY 14075 Phone: 716-646-3362 Fax: 716-646-3237
Karam C Sharma, D.M&S.P Psychologist Medicare: Not Enrolled in Medicare Practice Location: 166 Sherburn Dr, Hamburg, NY 14075 Phone: 716-816-2446 Fax: 716-816-2450

Dr Charles Jack, PHD - Medicare Psychologist in Hamburg, NY