MYCAH JACK FNP-BC
NPI 1396481693
Nurse Practitioner - Family in Knoxville, TN
About Mycah Jack Fnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MYCAH JACK FNP-BC (NPI 1396481693) is an individual family provider in Knoxville, Tennessee, licensed in Tennessee (31108) and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mycah Jack Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mycah Jack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Knoxville, TN 37920
- Reassigned Medicare billing, Tennessee enrollment
- 14 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 37920 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
KNOXVILLE, TN 37920
KNOXVILLE, TN 37920
KNOXVILLE, TN 37920
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 Mycah Jack's NPI number?
The NPI number for Mycah Jack is 1396481693. It was assigned to this individual provider in the NPPES registry on May 9, 2022.
Where is Mycah Jack located?
Mycah Jack practices at 1930 Alcoa Hwy, Knoxville, TN 37920. The listed phone number is (865) 263-2400.
What is Mycah Jack's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Mycah Jack enrolled in Medicare?
Yes. Mycah Jack is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Mycah Jack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mycah Jack reassigns Medicare benefits to University Emergency Obstetrics LLC (Knoxville, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mycah Jack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mycah Jack accept?
Health plans from BlueCross BlueShield of Tennessee, Cigna Healthcare, Oscar Insurance Company and UnitedHealthcare list Mycah Jack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mycah Jack was last updated on May 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mycah Jack, FNP-BC · NPI 1396481693
Family physician in Knoxville, Tennessee. Individual provider, active in the CMS NPPES registry since May 9, 2022.
## Identity
- **NPI:** 1396481693 (Entity type: Individual)
- **Enumerated:** May 9, 2022
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 31108 (Tennessee)
- **Sole proprietor:** No
## Practice location
- **Address:** 1930 ALCOA HWY, Knoxville, TN 37920-1500
- **Phone:** (865) 263-2400
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** University Emergency Obstetrics LLC (NPI 1629706445, Knoxville, TN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 9, 2022
---
Source: [NPI Profile](https://npiprofile.com/npi/1396481693) · Data from the CMS NPPES public registry.