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JACK D ANDERSON DO
NPI 1245527969
Family Medicine in Tompkinsville, KY

Active since July 01, 2011PECOS EnrolledAccepts Medicare Assignment
96.68/100
CMS Quality Rating
1515 EDMONTON RD, TOMPKINSVILLE, KY 42167(270) 487-9272(270) 487-6242 Get Directions Write a Review

NPPES record last updated: June 10, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jack D Anderson Do NPPES

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

JACK D ANDERSON DO (NPI 1245527969) is an individual family medicine provider in Tompkinsville, Kentucky, licensed in Kentucky (03464) and active in the NPI registry since July 2011. He is enrolled in Medicare PECOS, is affiliated with T J Samson Community Hospital, and is a graduate of University Of Pikeville, Kentucky College Of Osteopathic Med (2010).

NPPES Registry Identity

NPI1245527969
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJACK D ANDERSONCredential: DO
Location Address1515 EDMONTON RDTompkinsville, KY 42167-9402
Mailing AddressPo Box 1080Burkesville, KY 42717-1080 · (270) 864-1472 · Fax (270) 864-1693
Phone(270) 487-9272
Fax(270) 487-6242
Sole ProprietorNo
Medical School CMSUniversity Of Pikeville, Kentucky College Of Osteopathic MedGraduated 2010
Enumeration DateJuly 1, 2011
Last NPPES UpdateJune 10, 2014
✔ NPI 1245527969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in KY · 03464
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1515 EDMONTON RD, Tompkinsville, KY 42167
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Other Identifiers 2

Medicaid7100197370KY
Medicare PINK098360KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter of Tennessee and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jack D Anderson Do 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 ID6103095062
PECOS Enrollment IDI20110810000138
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Jack Anderson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Cumberland Family Medical Center Inc
0.2 mi
Federally Qualified Health Center (FQHC)
1515 EDMONTON RD
Tompkinsville, KY 42167
  • Reassigned Medicare billing, Kentucky enrollment
  • 276 clinicians in this Medicare group
NPI 1649516287 (270) 487-9272
Monroe Medical Foundation, Inc.
1.7 mi
Internal Medicine
529 CAPP HARLAN RD
Tompkinsville, KY 42167
  • Reassigned Medicare billing, Kentucky enrollment
  • 42 clinicians in this Medicare group
NPI 1134330848 (270) 487-9231

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 8

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
223 services66 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
78 services50 patients
Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221
Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.
60 services45 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
16 services16 patients
Automated urinalysis test 81003
An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
14 services11 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
12 services12 patients

Hospital Affiliations CMS Care Compare 2

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

T J Samson Community Hospital

Acute Care Hospitals · Glasgow, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number180017
Location1301 North Race StreetGlasgow, KY 42141 · Barren County
Emergency services Birthing friendly

Monroe County Medical Center

Acute Care Hospitals · Tompkinsville, KY
1/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number180105
Location529 Capp Harlan RoadTompkinsville, KY 42167 · Monroe County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 42167 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
$82.24 typical visit price
range $52.76 – $162.27
Typical copayment $20.56 (range $13.19 – $40.56)
Most-billed visit code 99203
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
Most-billed visit code 99214
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.

96.68/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality83.69
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 16

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
4 suppliers33 claims63 services$4.19 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
4 suppliers13 claims13 services$0.78 avg. paid by Medicare
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) A4314
DME-Orthotic Devices · category DF000N
1 supplier25 claims25 services$24.39 avg. paid by Medicare
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each A4357
DME-Orthotic Devices · category DF000N
1 supplier25 claims25 services$7.98 avg. paid by Medicare
Tape, waterproof, per 18 square inches A4452
DME-Medical/Surgical Supplies · category DA000N
1 supplier11 claims1,584 services$0.37 avg. paid by Medicare
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing A6402
DME-Medical/Surgical Supplies · category DA023N
1 supplier13 claims621 services$0.11 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 3

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

LAURA INABNITT DO
Family Medicine
1515 EDMONTON RD
TOMPKINSVILLE, KY 42167
Monroe County (270) 487-9272
DR. TIMOTHY DALE HUME M.D.
Family Medicine
1515 EDMONTON RD
TOMPKINSVILLE, KY 42167
Monroe County (270) 487-9272
CUMBERLAND FAMILY MEDICAL CENTER INC
Clinic/Center (Federally Qualified Health Center (FQHC))
1515 EDMONTON RD
TOMPKINSVILLE, KY 42167
Monroe County (270) 487-9272

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 Jack Anderson's NPI number?

The NPI number for Jack Anderson is 1245527969. It was assigned to this individual provider in the NPPES registry on July 1, 2011.

Where is Jack Anderson located?

Jack Anderson practices at 1515 Edmonton Rd, Tompkinsville, KY 42167. The listed phone number is (270) 487-9272.

What is Jack Anderson's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Jack Anderson enrolled in Medicare?

Yes. Jack Anderson 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.

Which organizations bill Medicare for Jack Anderson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Anderson reassigns Medicare benefits to 2 organizations: Cumberland Family Medical Center Inc (Tompkinsville, KY) and Monroe Medical Foundation, Inc. (Tompkinsville, KY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Anderson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Anderson accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter of Tennessee and Anthem Blue Cross and Blue Shield list Jack Anderson 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 Jack Anderson affiliated with any hospitals?

According to CMS data, Jack Anderson is affiliated with T J Samson Community Hospital and Monroe County Medical Center.

When was this NPI record last updated?

The NPPES record for Jack Anderson was last updated on June 10, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.