DR. AVANELLE V JACK (MD) – Nephrology Physician, NPI 1316996671
Nephrology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. AVANELLE V JACK (MD)
208 SCRANTON CONNECTOR STE 117
BRUNSWICK, GA 315250560
Phone: (912) 264-5961
Fax: (912) 262-9499
Type: Location
208 SCRANTON CONNECTOR
SUITE 117
BRUNSWICK, GA 31525
Phone: (912) 264-5961
Fax: (912) 262-9499
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $42.
Total Amount is formed as General ($42) + Research ($0) + Ownership ($0) = $42.
Last reported payment date: 2024-08-02 • Largest payer in this snapshot: Abbott Laboratories ($42).
Total Amount
$42
General + Research + Ownership
Payments
2
Total payment records
General Amount
$42
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-02
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $42 |
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: 2005-10-17
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 |
|---|---|---|---|---|
| I20051017000537 | I | Internal Medicine | LA | 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 |
|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 23 | 15 | $0 |
| 99202 | New patient office or other outpatient visit, 15-29 minutes | 14 | 14 | $0 |
Insurance plans in this area (ZIP 31525)
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