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

Jack Raymond Anderson

Individual provider Surgery Physician · NPI 1881166775

Jack Raymond Anderson is a Physician Assistant in Cleveland, Ohio. Qualified in 2018, 8 years ago. Practices with Lutheran Hospital, a 24-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
8
Licensed in
OH
In the registry since
2018
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Practice location Address checks out

1730 W 25th St
Cleveland, OH 44113-3108
Phone: (216) 903-7287
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 50.005645RX (OH)

Record details

NPI number1881166775
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 18, 2018
Last updated in NPPESDecember 18, 2018
Mailing address1730 W 25th St, Cleveland, OH 44113-3108

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Lutheran Hospital — 24 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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