DR. JACK VICTOR CARLISLE MD
NPI 1326023060
Family Medicine in Grand Rapids, MN

Q: What is Jack Carlisle's NPI number?

The NPI number for Jack Carlisle is 1326023060. It was assigned to this individual provider in the NPPES registry on December 14, 2005.

Q: What is Jack Carlisle's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jack Carlisle was last updated on February 12, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 14, 2005PECOS EnrolledAccepts Medicare Assignment

90.32/100

CMS Quality Rating

1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744(218) 326-5000(218) 326-1461 Get Directions Write a Review

NPPES record last updated: February 12, 2013. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Dr. Jack Victor Carlisle Md NPPES

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

DR. JACK VICTOR CARLISLE MD (NPI 1326023060) is an individual family medicine provider in Grand Rapids, Minnesota, licensed in Minnesota (31750) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS, is affiliated with Grand Itasca Clinic And Hospital, and is a graduate of Rush Medical College Of Rush University (1987).

NPPES Registry Identity

NPI1326023060

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. JACK VICTOR CARLISLECredential: MD

Location Address1601 GOLF COURSE RDGrand Rapids, MN 55744-8648

Mailing Address1601 Golf Course RdGrand Rapids, MN 55744-8648 · (218) 326-5000 · Fax (218) 326-1461

Phone(218) 326-5000

Fax(218) 326-1461

Sole ProprietorNo

Medical School CMSRush Medical College Of Rush UniversityGraduated 1987

Enumeration DateDecember 14, 2005

Last NPPES UpdateFebruary 12, 2013

✔ NPI 1326023060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in MN · 31750

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.

1601 GOLF COURSE RD, Grand Rapids, MN 55744

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Other Identifiers 3

Medicare ID-Type Unspecified080011638MN

Medicaid462700800MN

Medicare UPINA94467MN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Sanford Health Plan.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

Dr. Jack Victor Carlisle 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 ID244142412

PECOS Enrollment IDI20080304000641

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 4

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

49 services41 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

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.

43 services35 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

24 services23 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

21 services21 patients

Hospital Affiliations CMS Care Compare

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

Grand Itasca Clinic And Hospital

Acute Care Hospitals · Grand Rapids, MN

OwnershipVoluntary non-profit - Private

CMS Certification Number240064

Location1601 Golf Course RoadGrand Rapids, MN 55744 · Itasca County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55744 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

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

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.

90.32/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

93.18

Promoting Interoperability

100

Improvement Activities

Cost

65.92

Referred Medical Equipment & Supplies CMS DME claims 9

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

6 suppliers40 claims162 services$5.59 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

5 suppliers21 claims27 services$1.09 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

2 suppliers11 claims22 services$7.66 avg. paid by Medicare

Lubricant, per ounce A4402

DME-Orthotic Devices · category DF010N

1 supplier11 claims44 services$0.28 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

5 suppliers11 claims11 services$63.23 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

5 suppliers15 claims83 services$2.02 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 20

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

DR. EDWIN A. ANDERSON MD

Family Medicine