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DR. JACK ANDREW NELSON OMFS
NPI 1629166590
Dentist - Oral and Maxillofacial Surgery in Hampton Bays, NY

Active since October 10, 2006Opted out of Medicare · through Jun 2, 2028
240 W MONTAUK HWY, HAMPTON BAYS, NY 11946(631) 728-1300(631) 728-5165 Get Directions Write a Review

NPPES record last updated: March 10, 2016. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Jack Andrew Nelson Omfs NPPES

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

DR. JACK ANDREW NELSON OMFS (NPI 1629166590) is an individual oral and maxillofacial surgery provider in Hampton Bays, New York, licensed in New York (0429341) and active in the NPI registry since October 2006. He has opted out of Medicare through June 2, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1629166590
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. JACK ANDREW NELSONCredential: OMFS
Location Address240 W MONTAUK HWYHampton Bays, NY 11946-3510
Mailing Address240 W Montauk HwyHampton Bays, NY 11946-3510 · (631) 728-1300 · Fax (631) 728-5165
Phone(631) 728-1300
Fax(631) 728-5165
Sole ProprietorNo
Enumeration DateOctober 10, 2006
Last NPPES UpdateMarch 10, 2016
✔ NPI 1629166590 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in NY · 0429341
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
240 W MONTAUK HWY, Hampton Bays, NY 11946
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Other Identifiers 3

Medicaid01548470NY
Medicare ID-Type UnspecifiedD14271NY
Medicare UPINU55748

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jack Andrew Nelson Omfs has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 2, 2016 through June 2, 2028.

Opt-Out Effective DateJune 2, 2016
Opt-Out In Effect ThroughJune 2, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11946 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
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
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 4

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

EAST END ORAL SURGERY
Dentist (Oral and Maxillofacial Surgery)
240 W MONTAUK HWY
HAMPTON BAYS, NY 11946
Suffolk County (631) 728-1300
GABRIEL R ARIOLA MD
Emergency Medicine
240 W MONTAUK HWY
HAMPTON BAYS, NY 11946
Suffolk County (631) 728-4500
PRIME CARE MEDICAL OF LONG ISLAND, PC
Emergency Medicine
240 W MONTAUK HWY
HAMPTON BAYS, NY 11946
Suffolk County (631) 728-4500
MR. KENNWORTH EATON II P.A.
Physician Assistant
240 W MONTAUK HWY
HAMPTON BAYS, NY 11946
Suffolk County (631) 728-4500

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 Nelson's NPI number?

The NPI number for Jack Nelson is 1629166590. It was assigned to this individual provider in the NPPES registry on October 10, 2006.

Where is Jack Nelson located?

Jack Nelson practices at 240 W Montauk Hwy, Hampton Bays, NY 11946. The listed phone number is (631) 728-1300.

What is Jack Nelson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Jack Nelson enrolled in Medicare?

No. Jack Nelson has opted out of Medicare through June 2, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jack Nelson was last updated on March 10, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.