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Deactivated NPI 1881680213 Deactivated / Inactive NPI Male Practitioner

Dr. Jack Carter Roberts , MD

Surgery • Oak Lawn, IL

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

Registration / Start Date September 21, 2005
NPI Deactivation Date October 25, 2023
Total Practice Duration ~18 Years of Practice (2005 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Jack Roberts, MD was a registered Surgery practicing in Oak Lawn, IL. Throughout an active medical career spanning 18 years, Dr. Roberts provided care at the practice location at 4400 W 95TH ST until profile deactivation on 2023-10-25.

Practice Location & Contact Primary Location

Practice Address

4400 W 95th St
Suite 205

Oak Lawn, IL 604532654

Telephone 7083464040
Fax 7083463287
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Oak Lawn, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 25.3 Yrs
State Avg: 27.3 Yrs
Regional Practice Density
20 Specialists

Practicing in Oak Lawn, IL (1624 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

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License IL 036042020

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Practice Associates & Co-Workers

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

40 Associated Practitioners
Jacqueline Zdon , PA-C

Physician Assistant - Surgical

NPI 1003194796

Physician Assistant (Certified)

John Ancona , PA

Physician Assistant

NPI 1003891649

Physician Assistant

Dr. Joel Guillory , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1043582158

Doctor of Medicine (M.D.)

Dr. Nina Delavari , DO

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1053775163

Doctor of Osteopathic Medicine (D.O.)

Zachary Byington , PA-C

Physician Assistant - Surgical

NPI 1093568487

Physician Assistant (Certified)

Annie Pauwaa , PA-C

Physician Assistant - Surgical

NPI 1124069778

Physician Assistant (Certified)

Career & Practice History Timeline

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

8 Historical Events
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NPI Profile Deactivated October 25, 2023

Record deactivated on October 25, 2023

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 09, 2023

Thoracic Surgery (Cardiothoracic Vascular Surgery) (License #036042020 in IL)

NPI Profile Active February 22, 2012

NPI status registered as active in NPPES database

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Updated Practice Location February 22, 2012

Registered at 4400 W 95TH ST, SUITE 205, OAK LAWN, IL 604532654 (Tel: 7083464040)

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Updated Business Mailing Address February 22, 2012

Registered at 4400 W 95TH ST, SUITE 205, OAK LAWN, IL 604532654 (Tel: 7083464040)

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Provider Name / Credentials Updated February 22, 2012

Recorded as JACK ROBERTS, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 22, 2012

Surgery (License #036042020 in IL)

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Initial NPI Registration & Enumeration September 21, 2005

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: 1881680213
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 21, 2005
Last Update: February 22, 2012
Deactivation Date: October 25, 2023

Mailing Address

4400 W 95th St, Suite 205

Oak Lawn, IL 604532654

Phone: 7083464040

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.