Jack City, LLC
NPI 1376002931 · Durable Medical Equipment & Medical Supplies · Watertown, MA
Enrolled with Medicare as Dme Supplier - Physician - Unknown Physician Specialty · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Jack City, LLC is a Durable Medical Equipment & Medical Supplies organization in Watertown, MA (NPI 1376002931).
Provider details
- NPI number
- 1376002931
- Entity type
- Organization
- Primary specialty
- Durable Medical Equipment & Medical SuppliesSuppliers
- Organization subpart
- No
- Authorized official
- Codey Gillum, Ceo(617) 754-5000
Specialties & taxonomies
Suppliers
- Surgical Physician Assistant363AS0400X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
6 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (5)
- 125 Parker Hill AveBoston, MA 02120-2847Phone: (617) 754-5000
- 125 Parker Hill Ave # 550Boston, MA 02120-2847Phone: (617) 602-5707Fax: (877) 547-4951
- 125 Parker Hill Ave # 4Boston, MA 02120-2847Phone: (617) 754-6569Fax: (617) 154-6420
- 2014 Washington StNewton, MA 02462-1607Phone: (617) 243-6000
- 70 Walnut StWellesley, MA 02481-2135Phone: (774) 517-7555Fax: (617) 754-6420
Registry dates
- Enumerated
- 2019-03-13
- Last updated
- 2026-04-20
- Certified
- 2026-04-20
Frequently asked questions
- What is Jack City, LLC's NPI number?
- Jack City, LLC's National Provider Identifier (NPI) is 1376002931, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Jack City, LLC?
- Jack City, LLC is classified in the NPPES registry as Durable Medical Equipment & Medical Supplies (Suppliers).
- Where is Jack City, LLC located?
- Jack City, LLC's practice location on file with NPPES is 30 Center St, Watertown, MA 02472-4018.
- What is Jack City, LLC's phone number?
- The practice phone number listed in the NPPES registry for Jack City, LLC is (617) 393-1709.
- Does Jack City, LLC accept Medicare?
- Jack City, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Jack City, LLC?
- The authorized official listed on Jack City, LLC's NPPES record is Codey Gillum, Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Jack City, LLC's NPI active?
- Yes — Jack City, LLC's NPI (1376002931) is active in the NPPES registry as of the last update on 2026-04-20.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.