DR. RANDALL ELLIS JACK M.D.
NPI 1922044437
Obstetrics & Gynecology - Gynecology in Reno, NV

Q: What is Randall Jack's NPI number?

The NPI number for Randall Jack is 1922044437. It was assigned to this individual provider in the NPPES registry on June 22, 2006.

Q: What is Randall Jack's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology, specializing in Gynecology, with taxonomy code 207VG0400X.

Q: Is Randall Jack enrolled in Medicare?

No. Randall Jack has opted out of Medicare through April 1, 2027. 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.

Q: When was this NPI record last updated?

The NPPES record for Randall Jack was last updated on April 12, 2024. 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 June 22, 2006Opted out of Medicare · through Apr 1, 2027

635 INNOVATION DR STE 300, RENO, NV 89511(775) 329-6241(775) 329-4921 Get Directions Write a Review

NPPES record last updated: April 12, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 12, 2024, Nov 19, 2020 (2 updates tracked since 2020).

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About Dr. Randall Ellis Jack M.d. NPPES

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

DR. RANDALL ELLIS JACK M.D. (NPI 1922044437) is an individual gynecology provider in Reno, Nevada, licensed in Nevada (13040) and active in the NPI registry since June 2006. He has opted out of Medicare through April 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1922044437

Entity TypeIndividualMale

Primary Taxonomy207VG0400X

Provider Legal NameDR. RANDALL ELLIS JACKCredential: M.D.

Location Address635 INNOVATION DR STE 300Reno, NV 89511-2215

Mailing Address635 Innovation Dr Ste 300Reno, NV 89511-2215 · (775) 329-6241 · Fax (775) 329-4921

Phone(775) 329-6241

Fax(775) 329-4921

Sole ProprietorNo

Enumeration DateJune 22, 2006

Last NPPES UpdateApril 12, 20242 updates tracked since enumeration

NPPES CertifiedApril 12, 2024

✔ NPI 1922044437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & Gynecology · GynecologyAllopathic & Osteopathic Physicians

Taxonomy Code207VG0400X

License✔ Licensed in NV · 13040

Definition

A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions. Source: National Uniform Claim Committee

635 INNOVATION DR STE 300, Reno, NV 89511

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

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Opted out of Medicare

Dr. Randall Ellis Jack M.d. 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 April 1, 2015 through April 1, 2027.

Opt-Out Effective DateApril 1, 2015

Opt-Out In Effect ThroughApril 1, 2027Opt-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 89511 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

$131.25 typical visit price

range $57.07 – $173.24

Typical copayment $32.81 (range $14.26 – $43.31)

Most-billed visit code 99204

Established Patient

$71.14 typical visit price

range $18.27 – $140.96

Typical copayment $17.78 (range $4.56 – $35.24)

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.

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Other Providers at the Same Location NPPES 19

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

MACKENZIE ROSETTE APRN

Nurse Practitioner (Women's Health)