JACK D ANDERSON (DO) – Family Medicine Physician, NPI 1245527969
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,718 FAMILY PRACTICE in KY
Provider Addresses for JACK D ANDERSON (DO)
PO BOX 1080
BURKESVILLE, KY 427171080
Phone: (270) 864-1472
Fax: (270) 864-1693
Type: Mailing
1515 EDMONTON RD
TOMPKINSVILLE, KY 421679402
Phone: (270) 487-9272
Fax: (270) 487-6242
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 35 Open Payments records for all available years, with a total value of $552.
Total Amount is formed as General ($552) + Research ($0) + Ownership ($0) = $552.
Last reported payment date: 2024-12-04 • Largest payer in this snapshot: ABBVIE INC. ($121).
Total Amount
$552
General + Research + Ownership
Payments
35
Total payment records
General Amount
$552
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $121 |
| Lilly USA, LLC | $95 |
| PFIZER INC. | $34 |
| Takeda Pharmaceuticals U.S.A., Inc. | $34 |
| IDORSIA PHARMACEUTICALS US INC | $33 |
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: 2011-08-10
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110810000138 | I | Family Practice | KY | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 232 | 74 | $0 |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | 75 | 47 | $0 |
| 99238 | Hospital discharge day management, 30 minutes or less | 75 | 47 | $0 |
| 99239 | Hospital discharge day management, more than 30 minutes | 24 | 23 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 23 | 23 | $0 |
Insurance plans in this area (ZIP 42717)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | KY | 85610 | Blood test, clotting time | 65 | 17 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | KY | |
| Nurse Practitioner | KY | |
| Certified Nurse Midwife (Cnm) | KY | |
| Clinical Social Worker | KY | |
| Nurse Practitioner | KY | |
| Nurse Practitioner | KY | |
| Nurse Practitioner | KY | |
| O B S T E T R I C S/ G Y N E C O L O G Y | KY | |
| Certified Nurse Midwife (Cnm) | KY | |
| Nurse Practitioner | KY |
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