Doctor profile · Federal record

Dr. OMAR JACK, DO, PA-C

Student in an Organized Health Care Education/Training Program · Physician Assistant · Medical Physician Assistant · BUFFALO, NY

  • NPI 1144662909
  • MIPS 77.5 / 100 · 2023
  • 13 yrs on file
  • Licensed in 2 states
  • Male
  • Group practice
  • No sanctions

Practice & contact

NPPES Updated May 11, 2026
Primary practice
77 GOODELL ST STE 550
BUFFALO, NY 142031258
(716) 829-6108

Credentials & registration

NPPES · NUCC
NPI registered
July 2013 — 13 yrs on file
Profile last updated
March 26, 2024
Specialty taxonomy
390200000X — NUCC code
State licenses (2)
Georgia #1109724 · Pennsylvania #MA062538

Federal sanctions & exclusions

OIG LEIE Updated May 11, 2026

No sanctions, exclusions or revocations on file

Checked against OIG LEIE on NPI 1144662909. Last verified May 11, 2026.

Medicare procedures · 2023

Top services delivered

CMS Provider Utilization
Total services
11
Distinct HCPCS
1
Medicare allowed
$748
HCPCS Description Services Patients Avg allowed
99221 Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 11 11 $68

In context: peer comparison

Among 7 peers in this city , average services per provider: 120. This provider delivers 0.1× the peer median.