Deactivated NPI 1710984968 Deactivated / Inactive NPI Male Practitioner

Dr. Jack D Real , MD

Urology • Dothan, AL

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jack Real has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 01, 2005

NPI Deactivation Date April 29, 2023

Total Practice Duration ~18 Years of Practice (2005 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Jack Real, MD was a registered Urology practicing in Dothan, AL. Throughout an active medical career spanning 18 years, Dr. Real provided care at the practice location at 1118 ROSS CLARK CIR until profile deactivation on 2023-04-29.

Historical Medicare Part B clinical services included outpatient office visit, removal of skin and tissue, 20.0 sq cm or less, established patient outpatient office visit. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1118 Ross Clark Cir
500

Dothan, AL 363013001

Telephone 3347944159

Fax 3347927019

Associated Practice Facility / Clinic

🏢 Wiregrass Surgical Associates, P.c. Facility NPI 1750387833

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Dothan, AL

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 33.7 Yrs

State Avg: 27.5 Yrs

Regional Practice Density

13 Specialists

Practicing in Dothan, AL (205 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

56.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2020)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	90	29	$30.00	$9.00
11042 Removal of skin and tissue, 20.0 sq cm or less	29	14	$118.00	$57.32
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	26	19	$60.00	$24.97

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	144	61	$27.00	$8.71
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	127	68	$58.00	$24.05
11042 Removal of skin and tissue, 20.0 sq cm or less	113	59	$116.82	$57.08
99183 Management and supervision of oxygen chamber therapy per session	92	17	$165.00	$103.18
99213 Established patient office or other outpatient visit, typically 15 minutes	31	24	$97.00	$48.39

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	202	94	$58.00	$24.42
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	199	69	$27.00	$8.82
11042 Removal of skin and tissue, 20.0 sq cm or less	176	80	$112.00	$58.64
99183 Management and supervision of oxygen chamber therapy per session	160	31	$165.00	$105.48
11045 Removal of skin and tissue, each additional 20.0 sq cm or less	57	17	$40.00	$25.19
97597 Removal of tissue from wound, 20.0 sq cm or less	47	30	$109.00	$23.57
99213 Established patient office or other outpatient visit, typically 15 minutes	40	35	$97.00	$49.43
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	32	16	$136.00	$81.19
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$143.00	$73.35

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	336	128	$63.55	$22.95
11042 Removal of skin and tissue, 20.0 sq cm or less	202	97	$242.82	$56.29
99183 Management and supervision of oxygen chamber therapy per session	190	24	$241.23	$100.19
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	98	36	$50.63	$8.54
11045 Removal of skin and tissue, each additional 20.0 sq cm or less	53	16	$46.21	$23.52
97597 Removal of tissue from wound, 20.0 sq cm or less	34	27	$107.53	$21.47
99213 Established patient office or other outpatient visit, typically 15 minutes	30	26	$98.40	$47.13
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	26	26	$149.19	$68.64
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	23	11	$150.26	$82.94
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	15	12	$182.67	$83.79

Medical Specialties & State Licenses

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License AL 00005009

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners

Dr. Joseph Phillips , MD

Urology

NPI 1013130186

Doctor of Medicine (M.D.)

Dr. Bryant Williams , MD

Urology

NPI 1053396606

Doctor of Medicine (M.D.)

Dr. Joseph Clements , MD

Urology

NPI 1295732204

Doctor of Medicine (M.D.)

Dr. Jonathan Vukovich , MD

Urology

NPI 1528065539

Doctor of Medicine (M.D.)

Dr. John Peacock , MD

Urology

NPI 1700883725

Doctor of Medicine (M.D.)

Dr. Mark Fischer , MD

Urology

NPI 1972501617

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events

⚠️

NPI Profile Deactivated April 29, 2023

Record deactivated on April 29, 2023

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 1118 ROSS CLARK CIR, 500, DOTHAN, AL 363013001 (Tel: 3347944159)

📍

Updated Business Mailing Address July 08, 2007

Registered at 1118 ROSS CLARK CIR, 500, DOTHAN, AL 363013001 (Tel: 3347944159)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as JACK REAL, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Urology (License #00005009 in AL)

🟢

Initial NPI Registration & Enumeration July 01, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews

No patient reviews submitted yet for Dr. Jack Real. Be the first to share your experience!

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1710984968

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 01, 2005

Last Update: July 08, 2007

Deactivation Date: April 29, 2023

Update or Correct Profile

Mailing Address

1118 Ross Clark Cir, 500

Dothan, AL 363013001

Phone: 3347944159

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.