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DR. AVANELLE V JACK MD
NPI 1316996671
Internal Medicine - Nephrology in Brunswick, GA

Active since May 06, 2006PECOS Enrolled
208 SCRANTON CONNECTOR STE 117, BRUNSWICK, GA 31525(912) 264-5961(912) 262-9499 Get Directions Write a Review

NPPES record last updated: October 24, 2017. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Avanelle V Jack Md NPPES

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

DR. AVANELLE V JACK MD (NPI 1316996671) is an individual nephrology provider in Brunswick, Georgia, licensed in Georgia (78666) and active in the NPI registry since May 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1316996671
Entity TypeIndividualFemale
Primary Taxonomy207RN0300X
Provider Legal NameDR. AVANELLE V JACKCredential: MD
Location Address208 SCRANTON CONNECTOR STE 117Brunswick, GA 31525-0560
Mailing Address208 Scranton Connector, Suite 117Brunswick, GA 31525 · (912) 264-5961 · Fax (912) 262-9499
Phone(912) 264-5961
Fax(912) 262-9499
Sole ProprietorNo
Enumeration DateMay 6, 2006
Last NPPES UpdateOctober 24, 2017
✔ NPI 1316996671 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
Licenses✔ Licensed in GA · 78666✔ Licensed in LA · MD.022645
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
208 SCRANTON CONNECTOR STE 117, Brunswick, GA 31525
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Other Names 1

Other Name (5)Dr. Avanelle V Jack-jackson Md

Other Identifiers 5

Medicare PIN4A574F668LA
Medicare PIN4A574F669LA
Medicaid1491501LA
Medicare PIN4A574LA
Medicare UPINH45588

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Avanelle V Jack Md 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

2

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

Louisiana State University School Of Medicine In New Orleans Faculty G
519 mi
Clinical Medical Laboratory
1901 PERDIDO STREET
New Orleans, LA 70112
  • Reassigned Medicare billing, Louisiana enrollment
  • 931 clinicians in this Medicare group
NPI 1508066283 (504) 568-6038
Main Street Physician Services LLC
619 mi
Hospitalist
2315 E MAIN ST
New Iberia, LA 70560
  • Reassigned Medicare billing, Louisiana enrollment
  • 93 clinicians in this Medicare group
NPI 1396150785 (800) 893-9698

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 31525 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
$124.10 typical visit price
range $53.31 – $164.04
Typical copayment $31.02 (range $13.32 – $41.01)
Most-billed visit code 99204
Established Patient
$94.84 typical visit price
range $16.68 – $133.24
Typical copayment $23.71 (range $4.17 – $33.31)
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.

Other Providers at the Same Location NPPES

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

BRUNSWICK URGENT CARE, LLC
Nurse Practitioner (Family)
208 SCRANTON CONNECTOR STE 117
BRUNSWICK, GA 31525
Glynn County (912) 574-5958

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 Avanelle Jack's NPI number?

The NPI number for Avanelle Jack is 1316996671. It was assigned to this individual provider in the NPPES registry on May 6, 2006. The provider is also known as Dr. Avanelle V Jack-Jackson MD.

Where is Avanelle Jack located?

Avanelle Jack practices at 208 Scranton Connector Ste 117, Brunswick, GA 31525. The listed phone number is (912) 264-5961.

What is Avanelle Jack's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Avanelle Jack enrolled in Medicare?

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

Which organizations bill Medicare for Avanelle Jack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Avanelle Jack reassigns Medicare benefits to 2 organizations: Louisiana State University School Of Medicine In New Orleans Faculty G (New Orleans, LA) and Main Street Physician Services LLC (New Iberia, LA). 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 Avanelle Jack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Avanelle Jack was last updated on October 24, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.