DR. JACK VICTOR CARLISLE (MD) – Family Medicine Physician, NPI 1326023060
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,075 FAMILY PRACTICE in MN
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Provider Addresses for DR. JACK VICTOR CARLISLE (MD)
Grand Itasca Clinic and Hospital, 1601, Golf Course Road, North Star Moblie Home Park, Grand Rapids, Itasca County, Minnesota, 55744, United States
GRAND RAPIDS, MN 557448648
Phone: (218) 326-5000
Fax: (218) 326-1461
Mailing address matches the actual address.
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: 2008-03-04
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 |
|---|---|---|---|---|
| I20080304000641 | I | Family Practice | MN | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 119 | 63 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 97 | 69 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 53 | 53 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 51 | 47 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 14 | 12 | $0 |
Insurance plans in this area (ZIP 55744)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | MN | 20610 | Aspiration and/or injection of large joint or joint capsule | 15 | 11 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MN | |
| Nurse Practitioner | MN | |
| Nurse Practitioner | MN | |
| - | MN | |
| General Surgery | MN | |
| Family Practice | MN | |
| Nurse Practitioner | MN | |
| - | MN | |
| Family Practice | MN | |
| Diagnostic Radiology | MN |
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