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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: August 09, 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
Phone(336) 768-9535
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
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Other Identifiers 3

OtherP01084809FL · Railroad Medicare
Medicaid005979900FL
Medicaid003125978AGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Samuel Porter Jacks Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8820245988
PECOS Enrollment IDI20151118002677
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
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.
37 services37 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
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.
25 services25 patients
Harvest of vein using an endoscope 33508
Harvesting a vein using an endoscope is a procedure where a small camera is used to help surgeons remove a vein from your body. This vein is often used to bypass a blocked artery, improving blood flow to your heart.
18 services18 patients
Coronary artery bypass using artery graft, 1 graft 33533
A coronary artery bypass with one artery graft is a surgical procedure to improve blood flow to your heart. An artery from another part of your body is used to bypass a blocked or narrowed coronary artery. This can help reduce chest pain and risk of heart attack.
17 services17 patients
Exam of lung with removal of lung lobe using an endoscope 32663
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.
11 services11 patients
Removal of lymph nodes of chest cavity using an endoscope 32674
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.
11 services11 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Novant Health Forsyth Medical Center

Acute Care Hospitals · Winston-Salem, NC
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number340014
Location3333 Silas Creek ParkwayWinston-Salem, NC 27103 · Forsyth County
Emergency services Birthing friendly

Novant Health Medical Park Hospital

Acute Care Hospitals · Winston-Salem, NC
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number340148
Location1950 S Hawthorne RdWinston-Salem, NC 27103 · Forsyth County

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$165.09 typical visit price
range $54.12 – $165.09
Typical copayment $41.27 (range $13.53 – $41.27)
Most-billed visit code 99205
Established Patient
$67.72 typical visit price
range $17.21 – $134.61
Typical copayment $16.93 (range $4.30 – $33.65)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
79%34 patients4/55-star benchmark: 100%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
70%47 patients3/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
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…
36%56 patients2/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRANDON JENKINS DMD
Dentist (General Practice)
4622 COUNTRY CLUB RD
WINSTON SALEM, NC 27104
Forsyth County (336) 765-3357
DR. JOEL CLARENCE MORGAN MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Forsyth County (336) 768-9535
DR. DAVID ALLEN DUNCAN MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON-SALEM, NC 27104
Forsyth County (336) 768-9535
NOVANT HEALTH MEDICAL GROUP, LLC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Forsyth County (336) 768-9535
DR. RONALD WILLIAM LOGAN JR. D.D.S.
Dentist (General Practice)
4622 COUNTRY CLUB RD, SUITE 240
WINSTON SALEM, NC 27104
Forsyth County (336) 760-9400
JESSICA NICIA STRICKLAND
Physician Assistant
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Forsyth County (336) 768-9535
DRS J LOVELAND AND R WALKER II, PLLC
Clinic/Center (Dental)
4622 COUNTRY CLUB RD
WINSTON SALEM, NC 27104
Forsyth County (336) 765-3357
LINDSAY SCALES MORGAN PA-C
Physician Assistant
4622 COUNTRY CLUB RD, SUITE 180
WINSTON SALEM, NC 27104
Forsyth County (336) 768-9535

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Jacks's NPI number?

The NPI number for Samuel Jacks is 1184828030. It was assigned to this individual provider in the NPPES registry on June 13, 2007.

Where is Samuel Jacks located?

Samuel Jacks practices at 4622 Country Club Rd Suite 180, Winston Salem, NC 27104. The listed phone number is (336) 768-9535.

What is Samuel Jacks's specialty?

The primary specialty registered for this NPI is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

Is Samuel Jacks enrolled in Medicare?

Yes. Samuel Jacks is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Samuel Jacks accept?

Health plans from Blue Cross and Blue Shield of NC list Samuel Jacks as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Samuel Jacks affiliated with any hospitals?

According to CMS data, Samuel Jacks is affiliated with Novant Health Forsyth Medical Center and Novant Health Medical Park Hospital.

When was this NPI record last updated?

The NPPES record for Samuel Jacks was last updated on October 25, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.