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

Jack Edward Runnels, DO

Individual provider Sports Medicine (Family Medicine) Physician · NPI 1710627617

Jack Edward Runnels, DO is a Sports Medicine in Concord, North Carolina. Graduated from Edward via Col of Osteo Medicine-Carolinas Campus in 2022, 4 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
4
Trained at
Edward via Col of Osteo Medicine-Carolinas Campus
Licensed in
NC
In the registry since
2022
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

5651 Poplar Tent Rd Ste 102
Concord, NC 28027-7686
Phone: (704) 782-4878
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X · Licence 2025-01850 (NC)

Record details

NPI number1710627617
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedMarch 30, 2022
Last updated in NPPESAugust 25, 2025
Certification dateAugust 25, 2025
Mailing address5651 Poplar Tent Rd Ste 102, Concord, NC 28027-7686

Medicare enrollment

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

Medicare specialtySPORTS MEDICINE
Also practisesFAMILY PRACTICE
Medical schoolEDWARD VIA COL OF OSTEO MEDICINE-CAROLINAS CAMPUS
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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