Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Jack Russelle Lake, DO

Individual provider Diagnostic Radiology Physician · NPI 1932248101

Jack Russelle Lake, DO practises Diagnostic Radiology in Albany, Georgia. Qualified in 2003, 23 years ago. Practices with South Jersey Radiology Associates P A, a 200-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia and Oklahoma.

Years since qualifying
23
Licensed in
GA, OK
In the registry since
2007
Specialties on file
2
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 →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

2624 Dawson Rd
Albany, GA 31707-1609
Phone: (229) 888-1624
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Additional practice locations (1)

  • 940 Ne 13th St, Oklahoma City, OK 73104-5008 — (405) 271-5125

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 4205 (OK)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 101304 (GA)

Record details

NPI number1932248101
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedFebruary 5, 2007
Last updated in NPPESOctober 30, 2024
Certification dateOctober 30, 2024

Medicare enrollment

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

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice South Jersey Radiology Associates P A — 200 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients1,669
Services billed 2,804 a service is one billed item, such as a visit, a test or a procedure
Average patient age73

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Colleagues at South Jersey Radiology Associates P A

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 200 clinicians in the practice; 12 are shown here.

Other providers in Albany