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JACK JOSEPH SUDEKUM
NPI 1558201533
Student in an Organized Health Care Education/Training Program in Beavercreek, OH

Active since March 30, 2026PECOS Enrolled
2145 N FAIRFIELD RD STE 100, BEAVERCREEK, OH 45431(937) 558-3900(937) 558-3999 Get Directions Write a Review

NPPES record last updated: March 30, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jack Joseph Sudekum NPPES

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

JACK JOSEPH SUDEKUM (NPI 1558201533) is an individual student in an organized health care education/training program in Beavercreek, Ohio and active in the NPI registry since March 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1558201533
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACK JOSEPH SUDEKUM
Location Address2145 N FAIRFIELD RD STE 100Beavercreek, OH 45431-2783
Mailing Address2145 N Fairfield Rd Ste 100Beavercreek, OH 45431-2783 · (937) 558-3900 · Fax (937) 558-3999
Phone(937) 558-3900
Fax(937) 558-3999
Sole ProprietorYes
Enumeration DateMarch 30, 2026
NPPES CertifiedMarch 30, 2026
✔ NPI 1558201533 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.
2145 N FAIRFIELD RD STE 100, Beavercreek, OH 45431
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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)

Jack Joseph Sudekum 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.

MATEO ALBERTO LEAL RODRIGUEZ MD
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
JORDAN CHRISTIAN COUNCELL MD
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
FATIMA ZEHRA BOUMAHCHAD
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
KATHERINE KRUEGER
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
DR. KATE GRAYSON MEIZLISH MD
Family Medicine
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
DR. REID MAXWELL FURSMIDT MD
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
JOHN HARTMAN
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900
DR. COURTNEY AMANDA BROWNE
Student in an Organized Health Care Education/Training Program
2145 N FAIRFIELD RD STE 100
BEAVERCREEK, OH 45431
Greene County (937) 558-3900

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 Sudekum's NPI number?

The NPI number for Jack Sudekum is 1558201533. It was assigned to this individual provider in the NPPES registry on March 30, 2026.

Where is Jack Sudekum located?

Jack Sudekum practices at 2145 N Fairfield Rd Ste 100, Beavercreek, OH 45431. The listed phone number is (937) 558-3900.

What is Jack Sudekum'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 Sudekum enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Jack Sudekum was last updated on March 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.