Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JACK Z NUSSBAUM MD
NPI 1346242690
Family Medicine in Lake Ronkonkoma, NY

Q: What is Jack Nussbaum's NPI number?

The NPI number for Jack Nussbaum is 1346242690. It was assigned to this individual provider in the NPPES registry on June 1, 2005.

Q: What is Jack Nussbaum'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 Nussbaum was last updated on July 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 01, 2005PECOS Enrolled

388 HAWKINS AVE, STE 1, LAKE RONKONKOMA, NY 11779(631) 588-8460(631) 588-8480 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Jack Z Nussbaum Md NPPES

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

JACK Z NUSSBAUM MD (NPI 1346242690) is an individual family medicine provider in Lake Ronkonkoma, New York, licensed in New York (165161) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS, is affiliated with St Catherine Of Siena Hospital Medical Center, and is a graduate of Icahn School Of Medicine At Mount Sinai (1984).

NPPES Registry Identity

NPI1346242690

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameJACK Z NUSSBAUMCredential: MD

Location Address388 HAWKINS AVE, STE 1Lake Ronkonkoma, NY 11779-4280

Mailing Address388 Hawkins Ave, Ste 1Lake Ronkonkoma, NY 11779-4280 · (631) 588-8460 · Fax (631) 588-8480

Phone(631) 588-8460

Fax(631) 588-8480

Sole ProprietorNo

Medical School CMSIcahn School Of Medicine At Mount SinaiGraduated 1984

Enumeration DateJune 1, 2005

Last NPPES UpdateJuly 13, 2026

✔ NPI 1346242690 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in NY · 165161

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.

388 HAWKINS AVE, Lake Ronkonkoma, NY 11779

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Other Identifiers 1

Medicaid01824322NY

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 Z Nussbaum 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 ID7810031598

PECOS Enrollment IDI20100218000461

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 15

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 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.

820 services262 patients

Urinalysis, manual test 81002

A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.

809 services253 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

784 services261 patients

Blood test, lipids (cholesterol and triglycerides) 80061

A lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.

513 services189 patients

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.

232 services174 patients

X-ray of chest, 2 views 71046

A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.

184 services162 patients

Urine microalbumin (protein) level 82043

The urine microalbumin level test measures the amount of a protein called albumin in your urine. This test helps to detect early signs of kidney damage. High levels of albumin may suggest your kidneys aren't functioning properly. It's a simple, non-invasive test that involves providing a urine sample.

96 services63 patients

Annual depression screening, 5 to 15 minutes G0444

An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.

84 services84 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

81 services77 patients

Stool analysis for blood, by fecal hemoglobin determination by immunoassay 82274

A stool analysis for blood, or fecal hemoglobin determination by immunoassay, is a test that checks for hidden blood in your stool. This test helps identify potential issues in your digestive system. It involves collecting a small stool sample which is then analyzed in a lab for the presence of blood.

54 services53 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

45 services38 patients

Influenza vaccine, inactivated 90653

The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.

38 services38 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

38 services38 patients

Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow G0181

This service involves a physician overseeing your care while you receive Medicare-covered services from a home health agency. The care you're receiving is complex and involves various disciplines. The physician isn't physically present but regularly supervises your treatment to ensure optimal health outcomes.

19 services11 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

13 services13 patients

Hospital Affiliations CMS Care Compare

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

St Catherine Of Siena Hospital Medical Center

Acute Care Hospitals · Smithtown, NY

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number330401

Location50 Route 25ASmithtown, NY 11787 · Suffolk County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11779 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

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.

Reported Quality Measures

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

88%2,002 patients3/55-star benchmark: 100%

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

100%10,014 patients5/55-star benchmark: 100%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

86%467 patients4/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

96%699 patients4/55-star benchmark: 100%

Use of High-Risk Medications in the Elderly

Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.

Lower rates are better for this measure.

Patients 2+: 9% · 436 patients

18%436 patients1/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 5

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 suppliers14 claims50 services$6.69 avg. paid by Medicare

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

1 supplier11 claims11 services$913.40 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

2 suppliers22 claims22 services$2.86 avg. paid by Medicare

Standard wheelchair K0001

DME-Wheelchairs · category DD000N

2 suppliers33 claims33 services$13.59 avg. paid by Medicare

Elevating leg rests, pair (for use with capped rental wheelchair base) K0195

DME-Wheelchairs · category DD021N

1 supplier17 claims17 services$5.82 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 9

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

THEODORE FRIED BURFORD WELCH & DAVID HAUER MD, PC

Family Medicine

388 HAWKINS AVE, SUITE 1
LAKE RONKONKOMA, NY 11779

Suffolk County (631) 588-8460

HEARING PROFESSIONALS OF AMERICA LLC

Hearing Aid Equipment

388 HAWKINS AVE
LAKE RONKONKOMA, NY 11779

Suffolk County (888) 612-1267

DR. GEORGE DANIEL EMMONS DPM

Podiatrist

388 HAWKINS AVE
LAKE RONKONKOMA, NY 11779

Suffolk County (631) 585-0045

GEORGE D EMMONS DPM PC

Podiatrist

388 HAWKINS AVE
LAKE RONKONKOMA, NY 11779

Suffolk County (631) 585-0045

MICHELE ESPINOSA

Optometrist

388 HAWKINS AVE, SUITE 2
LAKE RONKONKOMA, NY 11779

Suffolk County (631) 588-7004

PSCG OPTICS INC

Optometrist

388 HAWKINS AVE, SUITE 2
LAKE RONKONKOMA, NY 11779

Suffolk County (631) 588-7004

DR. LAURA ANN BUCCELLATO OD

Optometrist

388 HAWKINS AVE, SUITE 2
RONKONKOMA, NY 11779

Suffolk County (631) 588-7004

MANUEL R ROSALES MD

Family Medicine

388 HAWKINS AVE, STE 1
LAKE RONKONKOMA, NY 11779

Suffolk County (631) 588-8460

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 Nussbaum's NPI number?

The NPI number for Jack Nussbaum is 1346242690. It was assigned to this individual provider in the NPPES registry on June 1, 2005.

Where is Jack Nussbaum located?

Jack Nussbaum practices at 388 Hawkins Ave Ste 1, Lake Ronkonkoma, NY 11779. The listed phone number is (631) 588-8460.

What is Jack Nussbaum's specialty?

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

Is Jack Nussbaum enrolled in Medicare?

Yes. Jack Nussbaum 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.

Is Jack Nussbaum affiliated with any hospitals?

According to CMS data, Jack Nussbaum is affiliated with St Catherine Of Siena Hospital Medical Center.

When was this NPI record last updated?

The NPPES record for Jack Nussbaum was last updated on July 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.