NPIMap

Individual provider Active NPI

Jan Petrasek, M.D., PH.D.

  • Gastroenterology Physician
  • Dallas, TX
National Provider Identifier
1003251497
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
Q8602 Issued in TX
Practice address
5201 Harry Hines Blvd
Graduate Medical Education
Dallas, TX 75235-7708
Phone
(214) 590-8058
NPI assigned
Apr 30, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 27717 MS
Internal Medicine Physician 207R00000X 27717 MS
Student in an Organized Health Care Education/Training Program 390200000X BP10047494 TX
Gastroenterology Physician 207RG0100X Q8602 TX Primary

Addresses

Primary practice location

5201 Harry Hines Blvd
Graduate Medical Education
Dallas, TX 75235-7708

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180821001323 TX Practitioner - GastroenterologyPractitioner - Internal Medicine 7113276353 Reassigns benefits to 1 organization
I20201118003285 MS Practitioner - Internal MedicinePractitioner - Gastroenterology 7113276353 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Liver Consultants PAGroup PAC ID 6103063078, 36 clinicians

Practice addresses (Care Compare)

4318 Dezalva
Building 4 Unit 403
San Antonio, TX 78249-4374
Phone (210) 253-3426

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.9 of 100Reported as group
Quality
47.44
Promoting interoperability
98
Improvement activities
40
Cost
77.24

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
27717MSMDInternal Medicine Physician
BP10047494TXMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Dec 1, 2020 Accepting new patients
Texas Liver Consultants PA CurrentSince Dec 11, 2022 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Dec 1, 2020 Accepting new patients
Gastrointestinal Associates, P.a. Gastroenterology CurrentSince Jun 15, 2023 Accepting new patients
Gastrointestinal Associates, PA CurrentSince Jun 15, 2023 Accepting new patients

Locations

2510 Lakeland Dr
Flowood, MS 39232
Phone (601) 355-1234

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

1521 S Staples St
Ste 402
Corpus Christi, TX 78404
Phone (361) 883-1731

607 Camden St
Ste 108
San Antonio, TX 78215
Phone (210) 325-8402

4318 De Zavala Rd
Bldg 4
San Antonio, TX 78249

Networks

  • TX HMO
  • TX HMO D-SNP

Organizations & group practices 5

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1003251497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-4775",
            "fax_number": "601-815-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 HARRY HINES BLVD",
            "address_2": "GRADUATE MEDICAL EDUCATION",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357708",
            "telephone_number": "214-590-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRASEK",
        "first_name": "JAN",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-30",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MS",
            "license": "27717",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "27717",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10047494",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "Q8602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.