JACK BRADLEY ROYAL (M.D.) – Anesthesiology Physician, NPI 1134483878

JACK BRADLEY ROYAL (M.D.) is a healthcare provider. based in Gainesville, Florida. specializing in ANESTHESIOLOGY. They hold the professional credentials M.D.. They hold a License No. TRN17253 (FL). The NPI Number for JACK BRADLEY ROYAL (M.D.) is 1134483878

Main info

Male
Sole Proprietor
Accepts Medicare Assignment
Name
JACK BRADLEY ROYAL (M.D.)
NPI
1134483878
Phone
(229) 869-1527
Address
4000 NW 51ST ST
Enumeration Date
27 June 2012
Last Update Date
21 March 2021

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Secondary Phone
2292763100
Graduation Year
null (2026 years ago)
PAC ID
5597993691
Group Practice PAC ID
3870880792
Professional Enrollment ID
I20161031000047
Address ID
GA310153234CO902XXSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness75
Years active:13State licenses:1Digital endpointsOther names

3,340 ANESTHESIOLOGY in FL

Provider Addresses for JACK BRADLEY ROYAL (M.D.)

  • 4000 NW 51ST ST

    K204

    GAINESVILLE, FL 326064333

    Phone: (229) 869-1527

    Type: Mailing

  • 1600 SW ARCHER RD

    GAINESVILLE, FL 326103003

    Phone: (352) 265-0077

    Type: Location

  • 307 E 3RD AVE

    CORDELE, GA 310153208

    Phone: (229) 271-4656

    Type: Mailing

  • 1600 SW Archer Rd

    Gainesville, FL 326103003

    Phone: (352) 265-0077

    Type: Location

  • 902 N 7TH ST

    CORDELE, GA 310153234

    Phone: (229) 276-3100

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-10-31

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20161031000047IAnesthesiologyGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
00811Anesthesia for other procedure on large bowel using an endoscope3433$0
00813Anesthesia for procedure on small and large bowel using an endoscope2828$0
00731Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope2725$0
00910Anesthesia for other procedure on urinary system through urethra1513$0
00812Anesthesia for exam of colon using an endoscope1111$0
View full utilization report →

Insurance plans in this area (ZIP 32606)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3870880792View full group profile
NameSpecialtyState
-GA
Certified Registered Nurse Anesthetist (Crna)GA
-GA
Certified Registered Nurse Anesthetist (Crna)GA
Certified Registered Nurse Anesthetist (Crna)GA
A N E S T H E S I O L O G YGA
-GA
Anesthesiology AssistantFL
Certified Registered Nurse Anesthetist (Crna)GA
Certified Registered Nurse Anesthetist (Crna)GA

Reviews

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Frequently asked questions

Does JACK BRADLEY ROYAL (M.D.) share an NPI with anyone else?
NPI numbers are unique to each provider or organization — JACK BRADLEY ROYAL (M.D.) uses 1134483878.
Can I rely on JACK BRADLEY ROYAL (M.D.) being an active provider?
As of the registry snapshot, JACK BRADLEY ROYAL (M.D.) is marked active.
What is JACK BRADLEY ROYAL (M.D.)'s specialty?
The listing groups JACK BRADLEY ROYAL (M.D.) with Anesthesiology Physician. Clinical services aligned with this taxonomy classification.
Where should I expect JACK BRADLEY ROYAL (M.D.) on a map?
Expect Gainesville, Florida as a primary anchor for JACK BRADLEY ROYAL (M.D.) unless the record lists multiple sites.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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