SAMUEL PORTER JACKS MD
NPI 1184828030
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Winston Salem, NC

Active since June 13, 2007PECOS EnrolledAccepts Medicare Assignment
4622 COUNTRY CLUB RD, SUITE 180, WINSTON SALEM, NC 27104(336) 768-9535(336) 768-4155 Get Directions Write a Review

NPPES record last updated: October 25, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Samuel Porter Jacks Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL PORTER JACKS MD (NPI 1184828030) is an individual thoracic surgery (cardiothoracic vascular surgery) provider in Winston Salem, North Carolina, licensed in North Carolina (2015-01953) and active in the NPI registry since June 2007. He is enrolled in Medicare PECOS, is affiliated with Novant Health Forsyth Medical Center, and is a graduate of Wake Forest University School Of Medicine (2004).

NPPES Registry Identity

NPI1184828030
Entity TypeIndividualMale
Primary Taxonomy208G00000X
Provider Legal NameSAMUEL PORTER JACKSCredential: MD
Location Address4622 COUNTRY CLUB RD, SUITE 180Winston Salem, NC 27104-3769
Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (336) 768-9535 · Fax (336) 768-4155
Fax(336) 768-4155
Sole ProprietorNo
Medical School CMSWake Forest University School Of MedicineGraduated 2004
Enumeration DateJune 13, 2007
Last NPPES UpdateOctober 25, 2020
NPPES CertifiedSeptember 6, 2020
NPI 1184828030 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic Physicians
Taxonomy Code208G00000X
License Licensed in NC · 2015-01953
Definition

A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Also ListedSurgeryTaxonomy 208600000X · License 2015-01953 (NC)
4622 COUNTRY CLUB RD, Winston Salem, NC 27104

Other Identifiers 3

OtherP01084809FL · Railroad Medicare
Medicaid005979900FL
Medicaid003125978AGA

Accepted Insurance

Medicare Participation & PECOS Enrollment Status

Samuel Jacks is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Samuel Jacks is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 8820245988

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20151118002677

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Coronary artery bypass graft (CABG)

Coronary artery bypass graft (CABG) is a surgery to improve blood flow to your heart. It involves taking a blood vessel from another part of your body and using it to reroute blood around a blocked or narrowed artery in your heart. This can help reduce chest pain and minimize the risk of heart attacks.

This service was performed for 52 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 12 times for 12 patients

Exam of lung with removal of lung lobe using an endoscope

This is a procedure where an endoscope, a thin tube with a light and camera, is used to examine the lung and remove a lobe if necessary. It's less invasive than traditional surgery, resulting in shorter recovery time.

This service was performed 11 times for 11 patients

Initial hospital inpatient care per day, typically 70 minutes

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

This service was performed 15 times for 15 patients

New patient office or other outpatient visit, 60-74 minutes

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

This service was performed 53 times for 53 patients

Removal of lymph nodes of chest cavity using an endoscope

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to access and remove lymph nodes in the chest cavity. It's a minimally invasive method, which can help in diagnosing or treating certain conditions.

This service was performed 11 times for 11 patients

Replacement of aortic valve through the skin and femoral artery

This procedure, known as Transcatheter Aortic Valve Replacement (TAVR), involves replacing a damaged aortic valve through a small incision in the leg. A catheter is inserted into the femoral artery and guided up to the heart. The new valve is then positioned and deployed, restoring normal blood flow.

This service was performed 23 times for 23 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $41.27 for a new patient copayment and $16.93 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 27104 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99205

  • Average New Patient Price $165.09
  • Minimum New Patient Price $54.12
  • Maximum New Patient Price $165.09
  • Average New Patient Copayment $41.27
  • Minimum New Patient Copayment $13.53
  • Maximum New Patient Copayment $41.27

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $67.72
  • Minimum Established Patient Price $17.21
  • Maximum Established Patient Price $134.61
  • Average Established Patient Copayment $16.93
  • Minimum Established Patient Copayment $4.3
  • Maximum Established Patient Copayment $33.65

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure Performance Number of Patients
Colorectal Cancer Screening 79% 34
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Pneumococcal Vaccination Status for Older Adults 70% 47
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 36% 56
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Samuel Jacks is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
NOVANT HEALTH FORSYTH MEDICAL CENTER3333 SILAS CREEK PARKWAY
WINSTON-SALEM, NC 27103
(336) 718-5000Acute Care Hospitals

Other Providers at the Same Location


The following 13 providers are registered at the same or a nearby location.

Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Dentist (General Practice)
4622 COUNTRY CLUB RD, SUITE 240
WINSTON SALEM, NC 27104
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Physician Assistant
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Dentist (General Practice)
4622 COUNTRY CLUB RD, SUITE 280
WINSTON SALEM, NC 27104
Dentist
4622 COUNTRY CLUB RD, STE. 280
WINSTON SALEM, NC 27104
Clinic/Center (Dental)
4622 COUNTRY CLUB RD
WINSTON SALEM, NC 27104
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, STE 180
WINSTON-SALEM, NC 27104
Physician Assistant
4622 COUNTRY CLUB RD, SUITE 180
WINSTON-SALEM, NC 27104
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON-SALEM, NC 27104
Physician Assistant
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1184828030, enumerated as an "individual" on June 13, 2007.

The provider is located at 4622 COUNTRY CLUB RD SUITE 180 WINSTON SALEM, NC 27104 and the phone number is (336) 768-9535.

Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

The provider might be accepting Accepts: Blue Cross and Blue Shield of NC, Medicare and. Please consult your insurance carrier or call the provider to verify.

Samuel Jacks is affiliated with: NOVANT HEALTH FORSYTH MEDICAL CENTER.