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Deactivated NPI 1568902393 Deactivated / Inactive NPI Male Practitioner

Dr. Jack Weinstein , MD

General Practice • Villa Park, CA

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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 Weinstein has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 27, 2017
NPI Deactivation Date April 20, 2020
Total Practice Duration ~3 Years of Practice (2017 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Jack Weinstein, MD was a registered General Practice practicing in Villa Park, CA. Throughout an active medical career spanning 3 years, Dr. Weinstein provided care at the practice location at 17853 SANTIAGO BLVD STE 107-354 until profile deactivation on 2020-04-20.

Practice Location & Contact Primary Location

Practice Address

17853 Santiago Blvd Ste 107-354

Villa Park, CA 928614113

Telephone 7143238082
Fax 7149744461

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Villa Park, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 31.1 Yrs
Regional Practice Density
4 Specialists

Practicing in Villa Park, CA (2300 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License CA G21109

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated April 20, 2020

Record deactivated on April 20, 2020

NPI Profile Active February 27, 2017

NPI status registered as active in NPPES database

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Updated Practice Location February 27, 2017

Registered at 17853 SANTIAGO BLVD STE 107-354, VILLA PARK, CA 928614113 (Tel: 7143238082)

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Updated Business Mailing Address February 27, 2017

Registered at 17853 SANTIAGO BLVD STE 107-354, VILLA PARK, CA 928614113 (Tel: 7143238082)

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Provider Name / Credentials Updated February 27, 2017

Recorded as JACK WEINSTEIN, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 27, 2017

General Practice (License #G21109 in CA)

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Initial NPI Registration & Enumeration February 27, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1568902393
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 27, 2017
Last Update: February 27, 2017
Deactivation Date: April 20, 2020

Mailing Address

17853 Santiago Blvd Ste 107-354

Villa Park, CA 928614113

Phone: 7143238082

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.