Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JACK EDWARD RUNNELS DO
NPI 1710627617
Family Medicine - Sports Medicine in Longview, TX

Q: What is Jack Runnels's NPI number?

The NPI number for Jack Runnels is 1710627617. It was assigned to this individual provider in the NPPES registry on March 30, 2022.

Q: What is Jack Runnels's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Q: When was this NPI record last updated?

The NPPES record for Jack Runnels was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 days 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 March 30, 2022PECOS Enrolled

3133 GOOD SHEPHERD WAY, LONGVIEW, TX 75605(903) 323-6500(903) 315-4699 Get Directions Write a Review

NPPES record last updated: September 2, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Sep 2, 2026, Jul 8, 2022 (2 updates tracked since 2022).

On this page

About Jack Edward Runnels Do NPPES

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

JACK EDWARD RUNNELS DO (NPI 1710627617) is an individual sports medicine provider in Longview, Texas, licensed in Texas (W8428) and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Concord, and is a graduate of Edward Via Col Of Osteo Medicine-carolinas Campus (2022).

NPPES Registry Identity

NPI1710627617

Entity TypeIndividualMale

Primary Taxonomy207QS0010X

Provider Legal NameJACK EDWARD RUNNELSCredential: DO

Location Address3133 GOOD SHEPHERD WAYLongview, TX 75605-7921

Mailing Address5651 Poplar Tent Rd Ste 102Concord, NC 28027-7686

Phone(903) 323-6500

Fax(903) 315-4699

Sole ProprietorYes

Medical School CMSEdward Via Col Of Osteo Medicine-carolinas CampusGraduated 2022

Enumeration DateMarch 30, 2022

Last NPPES UpdateSeptember 2, 20262 updates tracked since enumeration

NPPES CertifiedSeptember 2, 2026

✔ NPI 1710627617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QS0010X

Licenses✔ Licensed in TX · W8428✔ Licensed in NC · 2025-01850

Definition

A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

3133 GOOD SHEPHERD WAY, Longview, TX 75605

Open in Google Maps ↗

Secondary Practice Location 1

Location 15651 Poplar Tent Rd Ste 102Concord, NC 28027-7686 · Phone (704) 782-4878

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

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 Edward Runnels 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 ID6608257498

PECOS Enrollment IDI20250917000314

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 75605 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

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

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 14

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

MRS. KRISTEL JUNE FREDERICKS MS, RD, LD

Dietitian, Registered