Doctor profile · Federal record
Dr. Nicole Jack, PA-C
Physician Assistant · Pontiac, IL
- NPI 1083104137
- Accepts Medicare
- MIPS 72.1 / 100 · 2023
- 9 yrs in practice
- Female
- Group practice
- No sanctions
Practice & contact
- Primary practice
-
2500 W Reynolds St
Pontiac, IL 61764
(815) 844-5343
fax (815) 844-5715
Credentials & registration
- NPI registered
- May 2018 — 8 yrs on file
- Profile last updated
- June 18, 2018
- Year of graduation
- 2017 — 9 yrs since
- Specialty taxonomy
- 363A00000X — NUCC code
- State license (1)
- Illinois #085006579
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1083104137. Last verified May 11, 2026.Medicare procedures · 2023
Top services delivered
Total services
88
Distinct HCPCS
2
Medicare allowed
$8,666
| HCPCS | Description | Services | Patients | Avg allowed | |
|---|---|---|---|---|---|
99214 |
Established patient office or other outpatient visit, 30-39 minutes | 73 | 64 | $104 | |
99213 |
Established patient office or other outpatient visit, 20-29 minutes | 15 | 15 | $74 |
In context: peer comparison
Among 2 peers in Pontiac Physician Assistant, average services per provider: 39. This provider delivers 2.3× the peer median.Medicare Part D · 2023
Top prescriptions
Total claims
165
Patients
0
Total drug cost
$2,719
| Drug | Type | Claims | Patients | Total cost |
|---|---|---|---|---|
| Metformin Hcl ER (Metformin Hcl) | Brand | 23 | 0 | $255 |
| Levothyroxine Sodium | Generic | 21 | 0 | $281 |
| Atorvastatin Calcium | Generic | 19 | 0 | $477 |
| Hydrochlorothiazide | Generic | 16 | 0 | $123 |
| Oxybutynin Chloride ER (Oxybutynin Chloride) | Brand | 15 | 0 | $756 |
| Lisinopril | Generic | 14 | 0 | $47 |
| Fluticasone Propionate | Generic | 12 | 0 | $101 |
| Lovastatin | Generic | 12 | 0 | $113 |
| Bupropion Hcl SR (Bupropion Hcl) | Brand | 11 | 0 | $290 |
| Omeprazole | Generic | 11 | 0 | $142 |
Hospital affiliations
Frequently asked questions
What is Dr. Nicole Jack's medical specialty?
Dr. Nicole Jack practices Physician Assistant in Pontiac, IL.
Where does Dr. Nicole Jack practice?
Dr. Nicole Jack practices at 2500 W Reynolds St, Pontiac, IL 61764. Office phone: 8158445343.
What is Dr. Nicole Jack's NPI?
Dr. Nicole Jack's National Provider Identifier (NPI) is 1083104137, issued by NPPES.
Does Dr. Nicole Jack accept Medicare assignment?
Yes. Dr. Nicole Jack accepts Medicare assignment, meaning Medicare-allowed amounts are accepted as full payment for covered services.
What procedures does Dr. Nicole Jack commonly perform?
Top Medicare-reported procedures in 2023: Established patient office or other outpatient visit (HCPCS 99214); Established patient office or other outpatient visit (HCPCS 99213). Source: CMS Medicare Physician & Other Practitioners file.