JACK RUSSELLE LAKE D.O.
NPI 1932248101
Radiology - Diagnostic Radiology in Albany, GA

Active since February 05, 2007PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
2624 DAWSON RD, ALBANY, GA 31707(229) 888-1624 Get Directions Write a Review

NPPES record last updated: October 30, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Jack Russelle Lake D.o. NPPES

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

JACK RUSSELLE LAKE D.O. (NPI 1932248101) is an individual diagnostic radiology provider in Albany, Georgia, licensed in Oklahoma (4205) and active in the NPI registry since February 2007. He is enrolled in Medicare PECOS, maintains a secondary practice location in Oklahoma City, and is a graduate of Other (2003).

NPPES Registry Identity

NPI1932248101
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameJACK RUSSELLE LAKECredential: D.O.
Location Address2624 DAWSON RDAlbany, GA 31707-1609
Mailing Address700 E Morehead St Ste 300Charlotte, NC 28202-2742
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateFebruary 5, 2007
Last NPPES UpdateOctober 30, 2024
NPPES CertifiedOctober 30, 2024
NPI 1932248101 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Licenses Licensed in OK · 4205 Licensed in GA · 101304
Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

2624 DAWSON RD, Albany, GA 31707

Secondary Practice Location 1

Location 1940 NE 13th St, 4G4250Oklahoma City, OK 73104-5008 · Phone (405) 271-5125 · Fax (405) 271-3462

Accepted 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 Russelle Lake D.o. 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 ID648323840
PECOS Enrollment IDI20090805000816
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.

Areas of Expertise CMS Part B claims 46

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

X-ray of chest, 1 view 71045
A chest X-ray, 1 view, is a quick, painless test that produces images of the structures within your chest, such as your heart, lungs, and blood vessels. It helps in diagnosing conditions like pneumonia, heart problems, or lung cancer. You'll stand in front of a machine that emits X-rays, which pass through your body to create the image.
1,069 services712 patients
Ct scan head or brain without contrast 70450
A CT scan of the head or brain without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your brain, skull, and other structures inside your head. It helps to detect conditions like strokes, tumors, or injuries. No dye (contrast) is used in this test.
251 services240 patients
X-ray of chest, 2 views 71046
A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
180 services170 patients
Mri scan of lower spinal canal without contrast 72148
An MRI scan of the lower spinal canal without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to produce detailed images of your lower spine. This helps identify issues like disc problems, tumors, or nerve conditions. No dye is used.
134 services134 patients
Mri scan of brain without contrast 70551
An MRI scan of the brain without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to create detailed images of your brain. It helps in detecting abnormalities like tumors, stroke, inflammation, or infection.
108 services108 patients
Complete ultrasound scan behind abdominal cavity 76770
A complete ultrasound scan behind the abdominal cavity is a non-invasive imaging procedure. It uses sound waves to create pictures of the structures and organs located at the back of your abdomen. It helps in diagnosing health conditions and monitoring ongoing treatments.
105 services103 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 31707 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
$83.23 typical visit price
range $53.31 – $164.04
Typical copayment $20.80 (range $13.32 – $41.01)
Most-billed visit code 99203
Established Patient
$66.89 typical visit price
range $16.68 – $133.24
Typical copayment $16.72 (range $4.17 – $33.31)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality100
Improvement Activities40

Other Providers at the Same Location NPPES 6

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

Clinic/Center (Magnetic Resonance Imaging (MRI))
2624 DAWSON RD
ALBANY, GA 31707
Clinic/Center (Radiology)
2624 DAWSON RD
ALBANY, GA 31707
Radiology (Diagnostic Radiology)
2624 DAWSON RD
ALBANY, GA 31707
Radiology (Diagnostic Radiology)
2624 DAWSON RD
ALBANY, GA 31707
Radiology (Diagnostic Radiology)
2624 DAWSON RD
ALBANY, GA 31707
Radiology (Diagnostic Radiology)
2624 DAWSON RD
ALBANY, GA 31707

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 Lake's NPI number?

The NPI number for Jack Lake is 1932248101. It was assigned to this individual provider in the NPPES registry on February 5, 2007.

Where is Jack Lake located?

Jack Lake practices at 2624 Dawson Rd, Albany, GA 31707. The listed phone number is (229) 888-1624.

What is Jack Lake's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Is Jack Lake enrolled in Medicare?

Yes. Jack Lake is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Jack Lake accept?

Health plans from Blue Cross and Blue Shield of Oklahoma list Jack Lake as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jack Lake was last updated on October 30, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.