Jack Russelle Lake, D.O.
NPI 1932248101ActiveIndividual· Radiology, Diagnostic Radiology· Albany, GA
Radiology, Diagnostic Radiology (D.O.) with South Jersey Radiology Associates P A and 2 other groups, practicing in Albany, Georgia. Medicare paid $70,753 for services to 1,669 patients in 2024.
Overview
| NPI | 1932248101 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | D.O. |
| Sole proprietor | No |
| NPI issued | Feb 5, 2007 |
| Last updated in NPPES | Oct 30, 2024 |
| Certified by provider | Oct 30, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Radiology, Diagnostic Radiology Primary | 2085R0202X | 4205 | OK |
| Radiology, Diagnostic Radiology | 2085R0202X | 101304 | GA |
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 - Diagnostic Radiology (GA); Practitioner - Diagnostic Radiology (OK) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 1,669 |
|---|---|
| Services billed | 2,804 across 142 procedure codes |
| Paid by Medicare | $70,753 |
Education and affiliations
| Graduation year | 2003 |
|---|---|
| Medicare specialty | Diagnostic Radiology |
Medical groups
- South Jersey Radiology Associates P AHouston, TX · 206 clinicians
- Pro Radiology LLCAtlanta, GA · 102 clinicians
- Synergy Radiology LLCConyers, GA · 72 clinicians
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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