Nicole M. Jack, PA-C
NPI 1083104137ActiveIndividual· Physician Assistant· Pontiac, IL
Physician Assistant (PA-C) with Memorial Physician Services, practicing in Pontiac, Illinois. Their prescriptions cost Medicare Part D more than their services did: $16,482 for 358 claims, against $7,566 paid for services in 2024. Lists Memorial Medical Center as a hospital affiliation.
Overview
| NPI | 1083104137 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | No |
| NPI issued | May 15, 2018 |
| Last updated in NPPES | Jun 18, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 085006579 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (IL) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 85 |
|---|---|
| Services billed | 150 across 17 procedure codes |
| Paid by Medicare | $7,566 |
Part D prescriptions in 2024
| Prescriptions (claims) | 358 · 627 30-day fills |
|---|---|
| Patients | 131 |
| Total drug cost | $16,482 |
| Generic share | 92% of claims |
Education and affiliations
| Graduation year | 2017 |
|---|---|
| Medicare specialty | Physician Assistant |
Medical group
- Memorial Physician ServicesChatham, IL · 165 clinicians
Hospital affiliation
- Memorial Medical CenterSpringfield, IL
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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