Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Jack Michael Brunson, PA-C

Individual provider Medical Physician Assistant · NPI 1174950661

Mr. Jack Michael Brunson, PA-C is a Physician Assistant in Elgin, Illinois. Qualified in 2013, 13 years ago. Accepts Medicare assignment. Licensed in Illinois, Indiana and Wisconsin.

Years since qualifying
13
Licensed in
IL, IN, WI
In the registry since
2013
Specialties on file
4
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1425 N Randall Rd
Elgin, IL 60123-2300
Phone: (847) 742-9800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.004840 (IL)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 085004840 (IL)
Physician Assistant Taxonomy 363A00000X · Licence 10002688A (IN)
Physician Assistant Taxonomy 363A00000X · Licence 853623 (WI)

Record details

NPI number1174950661
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 30, 2013
Last updated in NPPESNovember 24, 2025
Certification dateNovember 24, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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