Jack Russelle Lake, DO - Medicare Diagnostic Radiology in Oklahoma City, OK

Jack Russelle Lake, DO is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Oklahoma City, Oklahoma. He graduated from medical school in 2003 and has 21 years of diverse experience with area of expertise as Diagnostic Radiology. He is a member of the group practice Norman Radiology Services, Inc and his current practice location is 940 Ne 13th St, 4g4250, Oklahoma City, Oklahoma. You can reach out to his office (for appointments etc.) via phone at (405) 271-5125.

Jack Russelle Lake is licensed to practice in Oklahoma (license number 4205) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1932248101.

Contact Information

Jack Russelle Lake, DO
940 Ne 13th St, 4g4250,
Oklahoma City, OK 73104-5008
(405) 271-5125
(405) 271-3462



Physician's Profile

Full NameJack Russelle Lake
GenderMale
SpecialityDiagnostic Radiology
Experience21 Years
Location940 Ne 13th St, Oklahoma City, Oklahoma
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Jack Russelle Lake graduated from medical school in 2003
  NPI Data:
  • NPI Number: 1932248101
  • Provider Enumeration Date: 02/05/2007
  • Last Update Date: 01/26/2011
  Medicare PECOS Information:
  • PECOS PAC ID: 0648323840
  • Enrollment ID: I20090805000816

Medical Identifiers

Medical identifiers for Jack Russelle Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1932248101NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085R0202XRadiology - Diagnostic Radiology 4205 (Oklahoma)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Integris Southwest Medical CenterOklahoma city, OKHospital
Integris Baptist Medical Center, IncOklahoma city, OKHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Norman Radiology Services, Inc24664966418

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Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jack Russelle Lake allows following entities to bill medicare on his behalf.
Entity NameNorman Radiology Services, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1326039645
PECOS PAC ID: 2466496641
Enrollment ID: O20050617000884

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack Russelle Lake is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jack Russelle Lake, DO
940 Ne 13th St, 4g4250,
Oklahoma City, OK 73104-5008

Ph: () -
Jack Russelle Lake, DO
940 Ne 13th St, 4g4250,
Oklahoma City, OK 73104-5008

Ph: (405) 271-5125

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Radiology Doctors in Oklahoma City, OK

Dr. Jennifer Kathleen Hinkle, MD
Radiology
Medicare: Medicare Enrolled
Practice Location: 921 Ne 13th St, Oklahoma City, OK 73104
Phone: 405-456-2589    
Dr. Bryan Lee Vanzandt, M.D.
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 4625 S Western Ave, Oklahoma City, OK 73109
Phone: 405-632-2323    Fax: 405-631-9315
Charles Eric Eckman, M.D.
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 14101 Parkway Commons, Oklahoma City, OK 73134
Phone: 405-749-6277    
Robert K Gelczer, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 3433 Nw 56th St., Suite C-40, Oklahoma City, OK 73112
Phone: 405-945-4741    Fax: 888-972-5320
Vikas Vij, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 3433 Nw 56th St, Suite C-40, Oklahoma City, OK 73112
Phone: 405-945-4741    Fax: 888-972-5320
William G Phillips, MD
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 2224 Nw 50th St, Suite 276w, Oklahoma City, OK 73112
Phone: 405-858-2350    
Ronald Ray Magee, M.D.
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 5224 E I 240 Service Rd Ste 303, Oklahoma City, OK 73135
Phone: 405-608-3800    Fax: 405-628-6477

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