Jack Russelle Lake, D.O.
Diagnostic Radiology Physician · Albany, GA
Jack Russelle Lake, D.O. is a diagnostic radiology physician with a practice address in Albany, Georgia, and NPI 1932248101, issued on Feb 5, 2007. Check the license (Georgia 101304, as entered in NPPES) on the Georgia Composite Medical Board; the Medicare figures below come from public CMS files.
- Name
- Jack Russelle Lake
- Credential
- D.O.
- Primary taxonomy
- Diagnostic Radiology Physician 2085R0202X
- License numbers
- 101304 GA
4205 OK
Self-reported in NPPES; status is on the state search - Practice location
- 2624 Dawson RD, Albany, GA 31707
- Phone
- (229) 888-1624
- Enumerated
- Feb 5, 2007
- Record last updated
- Oct 30, 2024
- Medicare enrollment
- Enrolled (PECOS I20090805000816); accepts Medicare assignment
- Entity
- Type 1 · individual
Also registered at 2624 Dawson RD
A shared address usually means a shared clinic or building; it does not show who employs whom.
- David Costantino, MDDiagnostic Radiology Physician1518167725
- Nicholas Gutierrez, M.D.Diagnostic Radiology Physician1457643033
- Michael Im, M.D.Diagnostic Radiology Physician1710154794
- Joseph Pietron, DODiagnostic Radiology Physician1134742844
- Michael Ramalia, DODiagnostic Radiology Physician1043831852
- Robert Stickle, MDDiagnostic Radiology Physician1255320685
Verify Jack Russelle Lake in five checks
- 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
- 2LicenseActive license and public ordersGeorgia Composite Medical Board
Search for license 101304Check the board - 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
- 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
- 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
The practice group's MIPS final score for 2023 (Medicare payment program): 100 of 100
The Merit-based Incentive Payment System score is reported for the practice group, not for one clinician alone. Four categories are weighted into the final score; the average among 454,083 clinicians with a measured score was 83.5.
Source: CMS Quality Payment Program, MIPS performance year 2023, group reporting; category weights for 2023 (qpp.cms.gov).
Bills Medicare through 3 group practices
- Pro Radiology LLCChoctaw, OK
- South Jersey Radiology Associates P AChoctaw, OK
- Synergy Radiology LLCChoctaw, OK
Source: CMS Doctors and Clinicians National Downloadable File (the group practices a clinician bills Medicare through) (data.cms.gov).
Diagnostic Radiology Physician providers in Georgia
There are 1,065 diagnostic radiology physician records in Georgia.
Other diagnostic radiology physician records in Georgia
- William Abbott, MDAlbany, GA1760489744
- John Abernathy, MDColumbus, GA1780678573
- Jacob Abraham, MDAtlanta, GA1144271800
- Benjamin Adams, DOAtlanta, GA1730640673
- Timothy Adams, M.D.Evans, GA1558700088
- Neha AgrawalGainesville, GA1093058562
- Absar Ahmed, M.D.Atlanta, GA1144435124
- Asmaa AhmedAugusta, GA1730680570
- Mohamed Tarek Ahmed, MD, MSCAtlanta, GA1922627488
- Michael Aho, MDSnellville, GA1477729051
Common questions
What is Jack Russelle Lake, D.O.'s NPI number?
Jack Russelle Lake, D.O.'s National Provider Identifier (NPI) is 1932248101, issued on Feb 5, 2007. An NPI identifies a provider in billing; it is not a license.
Where is Jack Russelle Lake, D.O. located?
The NPPES record lists a practice address at 2624 Dawson RD, Albany, GA, 31707. Phone: (229) 888-1624. Providers update this record themselves, so call before visiting.
How can I verify Jack Russelle Lake, D.O.'s license?
NPPES lists Georgia license number 101304, as entered by the provider. Search the Georgia Composite Medical Board at https://medicalboard.georgia.gov/. The NPPES record confirms identity only; the state search shows license status, expiration and public orders.
What is Jack Russelle Lake, D.O.'s MIPS final score?
The 2023 MIPS final score is 100 of 100, reported for the practice group. The average among 454,083 clinicians with a measured score was 83.5.
Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. Medicare files from data.cms.gov. An NPI identifies who bills; it is not a license.
Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.