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RICHARD ANTHONY JACK M.D.
NPI 1306289129
Pediatrics - Neonatal-Perinatal Medicine in Tarzana, CA

Active since April 10, 2013PECOS Enrolled
18321 CLARK ST, TARZANA, CA 91356(818) 708-5570(818) 708-5471 Get Directions Write a Review

NPPES record last updated: December 28, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Richard Anthony Jack M.d. NPPES

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

RICHARD ANTHONY JACK M.D. (NPI 1306289129) is an individual neonatal-perinatal medicine provider in Tarzana, California, licensed in California (C175889) and active in the NPI registry since April 2013. He is enrolled in Medicare PECOS and maintains a secondary practice location in Hershey.

NPPES Registry Identity

NPI1306289129
Entity TypeIndividualMale
Primary Taxonomy2080N0001X
Provider Legal NameRICHARD ANTHONY JACKCredential: M.D.
Location Address18321 CLARK STTarzana, CA 91356-3501
Mailing Address4140 W 190th StTorrance, CA 90504-5513
Phone(818) 708-5570
Fax(818) 708-5471
Sole ProprietorNo
Enumeration DateApril 10, 2013
Last NPPES UpdateDecember 28, 2022
NPPES CertifiedDecember 28, 2022
✔ NPI 1306289129 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080N0001X
License✔ Licensed in CA · C175889
Definition
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
18321 CLARK ST, Tarzana, CA 91356
Open in Google Maps ↗

Secondary Practice Location 1

Location 1500 University Dr, H085Hershey, PA 17033-2360 · Phone (917) 405-2405

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Kaiser Permanente.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Richard Anthony Jack M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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

4

Medicare enrollment records show Richard Jack reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Queens North Hawaii Community Hospital
2,469 mi
Home Health
67-1125 MAMALAHOA HWY
Kamuela, HI 96743
  • Reassigned Medicare billing, Hawaii enrollment
  • 277 clinicians in this Medicare group
NPI 1124009584 (808) 881-4400
Kapiolani Medical Center For Women & Children
2,547 mi
Multi-Specialty
1319 PUNAHOU ST
Honolulu, HI 96826
  • Reassigned Medicare billing, Hawaii enrollment
  • 262 clinicians in this Medicare group
NPI 1548215692 (808) 983-6000
Kapiolani Medical Specialists
2,547 mi
Multi-Specialty
1319 PUNAHOU ST
Honolulu, HI 96826
  • Reassigned Medicare billing, Hawaii enrollment
  • 370 clinicians in this Medicare group
NPI 1124071014 (808) 983-8736
Hawaii Permanente Medical Group Inc
2,549 mi
Health Maintenance Organization
3288 MOANALUA RD
Honolulu, HI 96819
  • Reassigned Medicare billing, Hawaii enrollment
  • 1,187 clinicians in this Medicare group
NPI 1710945969 (808) 432-0000

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

Other Providers at the Same Location NPPES 20

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

DR. JONATHAN ANDREW PRINCE M.D.
Emergency Medicine
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5170
ART ONCOLOGY INC
Radiology (Diagnostic Radiology)
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (215) 313-0024
DR. NEIL ERIC CANBY M.D.
Emergency Medicine
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5170
KELLY ANN ARCHER KAMINSKI OTR/L
Occupational Therapist
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 881-0800
DR. FREDERICK THEODORE DENNIS M.D.
Emergency Medicine
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5170
KIMBERLY DANG PHAM
Pharmacist
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 881-0800
CAROL V GREENE NNP
Nurse Practitioner (Neonatal)
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5242
CARMEN BOTERO, MD
Pediatrics (Pediatric Critical Care Medicine)
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (208) 676-9080

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 Richard Jack's NPI number?

The NPI number for Richard Jack is 1306289129. It was assigned to this individual provider in the NPPES registry on April 10, 2013.

Where is Richard Jack located?

Richard Jack practices at 18321 Clark St, Tarzana, CA 91356. The listed phone number is (818) 708-5570.

What is Richard Jack's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Is Richard Jack enrolled in Medicare?

Yes. Richard Jack is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Richard Jack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Richard Jack reassigns Medicare benefits to 4 organizations: Queens North Hawaii Community Hospital (Kamuela, HI), Kapiolani Medical Center For Women & Children (Honolulu, HI), Kapiolani Medical Specialists (Honolulu, HI) and Hawaii Permanente Medical Group Inc (Honolulu, HI). 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 Richard Jack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Richard Jack accept?

Health plans from Kaiser Permanente list Richard Jack 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.

When was this NPI record last updated?

The NPPES record for Richard Jack was last updated on December 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.