Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jack Victor Carlisle, MD

Individual provider Family Medicine Physician · NPI 1326023060

Dr. Jack Victor Carlisle, MD is a Family Practice in Grand Rapids, Minnesota. Graduated from Rush Medical College of Rush University in 1987, 39 years ago. Practices with Grand Itasca Clinic and Hospital, a 325-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
39
Trained at
Rush Medical College of Rush University
Licensed in
MN
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone: (218) 326-5000
Fax: (218) 326-1461
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 31750 (MN)

Record details

NPI number1326023060
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedDecember 14, 2005
Last updated in NPPESFebruary 12, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolRUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
Graduated 1987 (39 years in practice)
Group practice Grand Itasca Clinic And Hospital — 325 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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