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

Individual provider Certified Registered Nurse Anesthetist · NPI 1972995280

Jeremiah Jack, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Vallejo, California. Qualified in 2014, 12 years ago. Practices with Permanente Medical Group Inc, a 10,941-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
12
Licensed in
CA
In the registry since
2015
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

975 Sereno Dr
Vallejo, CA 94589-2441
Phone: (707) 651-3884
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 95000285 (CA)

Record details

NPI number1972995280
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedFebruary 24, 2015
Last updated in NPPESDecember 30, 2021
Mailing address975 Sereno Dr, Vallejo, CA 94589-2441

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Permanente Medical Group Inc — 10941 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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