Active NPI
Jill Michelle Whitley, PA-C
- Physician Assistant
- Bryan, TX
National Provider Identifier
1003072174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 604 E 27TH St
Bryan, TX 77803-4026 - Phone
- (979) 314-1336
- Fax
- (502) 385-6508
- NPI assigned
- Jul 29, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
604 E 27TH St
Bryan, TX 77803-4026
Mailing address
604 E 27TH St
Bryan, TX 77803-4026
Phone (979) 314-1336
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202438205 | Medicaid | TX | |
| 202438204 | Medicaid | TX | |
| 1003072174 | Other | TX | TRICARE |
| 892N51 | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CC HMS TX, PLLC | Past | Accepting new patients | |
| Jonathan a. Friedman, M.D., PLLC | Physician Assistant | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AIHHAA/Endpoint/AIHHAA
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Hospitalist Physician
- College Station, TX
- NPI 1659851293
-
- Physician Assistant
- Bryan, TX
- NPI 1629127212
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759190400000",
"number": "1003072174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "604 E 27TH ST",
"city": "BRYAN",
"state": "TX",
"postal_code": "778034026",
"telephone_number": "979-314-1336",
"fax_number": "502-385-6508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 E 27TH ST",
"city": "BRYAN",
"state": "TX",
"postal_code": "778034026",
"telephone_number": "979-314-1336",
"fax_number": "502-385-6508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITLEY",
"first_name": "JILL",
"middle_name": "MICHELLE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-29",
"last_updated": "2025-09-30",
"certification_date": "2025-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202438205",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202438204",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "1003072174",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "892N51",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bryan, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.