JACK OSULLIVAN DO
NPI 1649845264
General Practice in Jacksonville, FL

Q: What is Jack Osullivan's NPI number?

The NPI number for Jack Osullivan is 1649845264. It was assigned to this individual provider in the NPPES registry on May 25, 2021.

Q: What is Jack Osullivan's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Osullivan was last updated on September 22, 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.

Active since May 25, 2021PECOS EnrolledAccepts Medicare Assignment

2080 CHILD ST, JACKSONVILLE, FL 32214(902) 542-7300 Get Directions Write a Review

NPPES record last updated: September 22, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jack Osullivan Do NPPES

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

JACK OSULLIVAN DO (NPI 1649845264) is an individual general practice provider in Jacksonville, Florida, licensed in Virginia (0102207445) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS and is a graduate of Nova Southeastern College Of Osteo Medicine (2021).

NPPES Registry Identity

NPI1649845264

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameJACK OSULLIVANCredential: DO

Location Address2080 CHILD STJacksonville, FL 32214-5005

Mailing Address2080 Child StJacksonville, FL 32214-5005

Phone(902) 542-7300

Sole ProprietorNo

Medical School CMSNova Southeastern College Of Osteo MedicineGraduated 2021

Enumeration DateMay 25, 2021

Last NPPES UpdateSeptember 22, 2023

NPPES CertifiedSeptember 22, 2023

✔ NPI 1649845264 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in VA · 0102207445

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedMilitary Health Care ProviderTaxonomy 171000000X

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2080 CHILD ST, Jacksonville, FL 32214

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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 and accepts Medicare assignment

Jack Osullivan Do 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 ID6204219942

PECOS Enrollment IDI20250815001578

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.

MR. STEVEN LEE UNDHEIM IDC

Military Health Care Provider (Independent Duty Corpsman)