Edward Joseph Jack

Physician • Reno, NV

Active NPI 1568769867 Individual Practitioner Male Practitioner

Practice location in NPPES

3100 Mill St, Suite 206
Reno, NV 895022259

Call 7753488048 Location details and other listings

Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

NPI assigned on February 22, 2011; this date does not establish years in practice.
No Medicare Part B / Part D records for this NPI in the CMS files shown here. CMS covers only Medicare fee-for-service / Part D claims and omits records with fewer than 11 beneficiaries, so this does not show whether the provider accepts Medicare or prescribes.

Practice Location & Contact Primary Location

Practice Address

3100 Mill St
Suite 206

Reno, NV 895022259

Telephone 7753488048

Fax 7753488043

Before You Book

Paying without insurance? Prepare a cost-estimate request

Ask about interpreters and office accessibility

What Public CMS Data Show

These CMS figures cover limited populations and published records; they are not quality ratings or medical advice.

Physician: NPPES taxonomy is a reported classification, not proof of board certification.

NPI first issued

2011

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo · Report an error.

Specialties & License Numbers Reported to NPPES

Community Based Residential Treatment Facility, Mental Illness Primary Specialty

NUCC Taxonomy Code: 320800000X

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Nevada State Medical Licensing Board.

Look Up on State Board Site

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid ID

100511515 (NV)

Career & Practice History

NPI enumerated February 22, 2011.

No changes to the name, practice address, taxonomy or NPI status in this record have been observed in the monthly NPPES data files from January 2017 to August 2026.

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NPI Administrative Meta

NPI Number: 1568769867

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 22, 2011

Last Update: February 22, 2011

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

3100 Mill St, Suite 206

Reno, NV 895022259

Phone: 7753488048

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.