Dr Jack Everett Gross, EDD is a medicare enrolled "Psychologist - Clinical" provider in Concord, North Carolina. His current practice location is
101 Cabarrus Ave E, Concord, North Carolina. You can reach out to his office (for appointments etc.) via phone at
(888) 849-7379.
Dr Jack Everett Gross is licensed to practice in North Carolina (license number 1738) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1356632582.
Healthcare Provider's Profile
| Full Name | Dr Jack Everett Gross |
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| Gender | Male |
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| Speciality | Psychologist - Clinical |
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| Location | 101 Cabarrus Ave E, Concord, North Carolina |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1356632582
- Provider Enumeration Date: 04/21/2011
- Last Update Date: 12/16/2019
Medicare PECOS Information:
- PECOS PAC ID: 5890929004
- Enrollment ID: I20131002000235
Medical Identifiers
Medical identifiers for Dr Jack Everett Gross such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356632582 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 183500000X | Pharmacist | 13823 (North Carolina) | Secondary |
| 103TC0700X | Psychologist - Clinical | 1738 (North Carolina) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jack Everett Gross allows following entities to bill medicare on his behalf.
| Entity Name | Onsite Care Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1912338328
PECOS PAC ID: 7012149222
Enrollment ID: O20140422000656 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jack Everett Gross is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jack Everett Gross, EDD
101 Cabarrus Ave E,
Concord, NC 28025-3699
Ph: (888) 849-7379 | Dr Jack Everett Gross, EDD
101 Cabarrus Ave E,
Concord, NC 28025-3699
Ph: (888) 849-7379 |
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