DR. JACK MICHAEL TIETEMA MD
NPI 1326669391
Student in an Organized Health Care Education/Training Program in Philadelphia, PA

Q: What is Jack Tietema's NPI number?

The NPI number for Jack Tietema is 1326669391. It was assigned to this individual provider in the NPPES registry on May 1, 2020.

Q: What is Jack Tietema's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Tietema was last updated on May 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.

Active since May 01, 2020PECOS Enrolled

3400 SPRUCE ST, PHILADELPHIA, PA 19104(215) 662-2250(215) 615-3995 Get Directions Write a Review

NPPES record last updated: May 5, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Jack Michael Tietema Md NPPES

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

DR. JACK MICHAEL TIETEMA MD (NPI 1326669391) is an individual student in an organized health care education/training program in Philadelphia, Pennsylvania and active in the NPI registry since May 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1326669391

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. JACK MICHAEL TIETEMACredential: MD

Location Address3400 SPRUCE STPhiladelphia, PA 19104-4238

Mailing Address3400 Spruce StPhiladelphia, PA 19104-4238 · (215) 662-2250 · Fax (215) 615-3995

Phone(215) 662-2250

Fax(215) 615-3995

Sole ProprietorYes

Enumeration DateMay 1, 2020

Last NPPES UpdateMay 5, 2026

NPPES CertifiedMay 5, 2026

✔ NPI 1326669391 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3400 SPRUCE ST, Philadelphia, PA 19104

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack Michael Tietema 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.

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.

ELIZABETH FOGLIA MD

Pediatrics

3400 SPRUCE ST, 8 RAVDIN
PHILADELPHIA, PA 19104

Philadelphia County (215) 662-3228

JOEL M STEIN MD

Radiology (Diagnostic Radiology)

3400 SPRUCE ST
PHILADELPHIA, PA 19104

Philadelphia County (215) 662-3005

PRISCILLA NELSON M.D.

Anesthesiology

3400 SPRUCE ST, 6 DULLES
PHILADELPHIA, PA 19104

Philadelphia County (215) 349-8310

DR. JASON THOMAS ACKRIVO MD

Internal Medicine (Pulmonary Disease)

3400 SPRUCE ST
PHILADELPHIA, PA 19104

Philadelphia County (215) 614-0871

JEAN-PHILIPPE RICHARD DMD

Student in an Organized Health Care Education/Training Program

3400 SPRUCE ST
PHILADELPHIA, PA 19104

Philadelphia County (215) 662-6176

LEAH M LOPEZ PA-C

Physician Assistant (Medical)

3400 SPRUCE ST, 4 SILVERSTEIN
PHILADELPHIA, PA 19104

Philadelphia County (215) 662-7870

MONIQUE LORRAINE ROBERTS SALAHUB

Anesthesiology (Critical Care Medicine)

3400 SPRUCE ST
PHILADELPHIA, PA 19104

Philadelphia County (215) 662-4000

JOANIE M GARRATT MD

Radiology (Diagnostic Radiology)

3400 SPRUCE ST
PHILADELPHIA, PA 19104

Philadelphia County (215) 662-3000

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 Tietema's NPI number?

The NPI number for Jack Tietema is 1326669391. It was assigned to this individual provider in the NPPES registry on May 1, 2020.

Where is Jack Tietema located?

Jack Tietema practices at 3400 Spruce St, Philadelphia, PA 19104. The listed phone number is (215) 662-2250.

What is Jack Tietema's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jack Tietema enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Jack Tietema was last updated on May 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.