JACK LEE NETTLETON (M.D.) – Radiation Oncology Physician, NPI 1174523575
Radiation Oncology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for JACK LEE NETTLETON (M.D.)
PO BOX 1236
GRAND BLANC, MI 484803236
Phone: (810) 342-3800
Fax: (810) 342-3784
Type: Mailing
Beecher Road, Flint, Genesee County, Michigan, 48433, United States
SUITE A
FLINT, MI 485323661
Phone: (810) 342-3800
Fax: (810) 342-3784
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: 2004-02-07
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 |
|---|---|---|---|---|
| I20040207000199 | I | Radiation Oncology | MI | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48480)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| RADIATION ONCOLOGY | MI | 77263 | Management of radiation therapy, complex | 118 | 113 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Radiation Oncology | MI | |
| Radiation Oncology | MI | |
| Radiation Oncology | CA | |
| Radiation Oncology | MI | |
| Radiation Oncology | MA | |
| Radiation Oncology | MI | |
| - | MI | |
| Radiation Oncology | MI |
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