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JACK L. DONALDSON
NPI 1346000379
Student in an Organized Health Care Education/Training Program in Camillus, NY

Active since March 19, 2024PECOS EnrolledAccepts Medicare Assignment
4997 STAGECOACH RD, CAMILLUS, NY 13031(315) 744-0861 Get Directions Write a Review

NPPES record last updated: March 19, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Jack L. Donaldson NPPES

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

JACK L. DONALDSON (NPI 1346000379) is an individual student in an organized health care education/training program in Camillus, New York and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1346000379
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACK L. DONALDSON
Location Address4997 STAGECOACH RDCamillus, NY 13031-9774
Mailing Address4997 Stagecoach RdCamillus, NY 13031-9774
Phone(315) 744-0861
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateMarch 19, 2024
NPPES CertifiedMarch 19, 2024
✔ NPI 1346000379 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.
4997 STAGECOACH RD, Camillus, NY 13031
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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 and accepts Medicare assignment

Jack L. Donaldson 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 ID1759874613
PECOS Enrollment IDI20251201001232
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.

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 Donaldson's NPI number?

The NPI number for Jack Donaldson is 1346000379. It was assigned to this individual provider in the NPPES registry on March 19, 2024.

Where is Jack Donaldson located?

Jack Donaldson practices at 4997 Stagecoach Rd, Camillus, NY 13031. The listed phone number is (315) 744-0861.

What is Jack Donaldson'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 Donaldson enrolled in Medicare?

Yes. Jack Donaldson 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.

When was this NPI record last updated?

The NPPES record for Jack Donaldson was last updated on March 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.