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DR. CHARLES JACK PH.D.
NPI 1376201772
Psychologist - Clinical in Hamburg, NY

Active since December 02, 2021PECOS Enrolled
5178 PARKER RD, HAMBURG, NY 14075(716) 598-8827 Get Directions Write a Review

NPPES record last updated: November 24, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 24, 2023, Dec 2, 2021 (2 updates tracked since 2021).

About Dr. Charles Jack Ph.d. NPPES

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

DR. CHARLES JACK PH.D. (NPI 1376201772) is an individual clinical provider in Hamburg, New York, licensed in New Jersey (35SI00726500) and active in the NPI registry since December 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376201772
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. CHARLES JACKCredential: PH.D.
Location Address5178 PARKER RDHamburg, NY 14075
Mailing Address5178 Parker RdHamburg, NY 14075 · (716) 598-8827
Phone(716) 598-8827
Sole ProprietorYes
Enumeration DateDecember 2, 2021
Last NPPES UpdateNovember 24, 20232 updates tracked since enumeration
NPPES CertifiedDecember 2, 2021
✔ NPI 1376201772 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in NJ · 35SI00726500
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
Also ListedPsychologistTaxonomy 103T00000X
5178 PARKER RD, Hamburg, NY 14075
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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. Charles Jack Ph.d. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14075 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
$166.88 typical visit price
range $54.87 – $166.88
Typical copayment $41.72 (range $13.71 – $41.72)
Most-billed visit code 99205
Established Patient
$97.08 typical visit price
range $17.54 – $136.14
Typical copayment $24.27 (range $4.38 – $34.03)
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.

BHCOFWNY
Psychologist (Clinical)
5178 PARKER RD
HAMBURG, NY 14075
Erie County (716) 598-8827

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 Charles Jack's NPI number?

The NPI number for Charles Jack is 1376201772. It was assigned to this individual provider in the NPPES registry on December 2, 2021.

Where is Charles Jack located?

Charles Jack practices at 5178 Parker Rd, Hamburg, NY 14075. The listed phone number is (716) 598-8827.

What is Charles Jack's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Charles Jack enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Charles Jack was last updated on November 24, 2023. 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.