Jackie E Wanebo, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

J9428 Issued in TX

Practice address

7900 Fannin St
Suite #3300
Houston, TX 77054-2934

Phone

(713) 630-0660

Fax

(713) 796-2555

NPI assigned

Nov 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: jwanebo5872@prddirect.texaschildrens.org

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.

• TCH Pediatric Associates, Inc

  • Pediatrics Physician
  • Sugar Land, TX
  • NPI 1861492654
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003981663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 FANNIN ST",
            "address_2": "SUITE #3300",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770542934",
            "telephone_number": "713-630-0660",
            "fax_number": "713-796-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 FANNIN ST",
            "address_2": "SUITE #3300",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770542934",
            "telephone_number": "713-630-0660",
            "fax_number": "713-796-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANEBO",
        "first_name": "JACKIE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J9428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127069603",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summer Wan
• Zhou Wan, ACUPUNCTURIST
• Matthew A Wanat, PHARMD
• William Allen Wandell, PHD
• Michael W. Wandling, MD, MS
• Wang Smiles Orthodontics PLLC
• Aileen Yuanqing Wang, D.D.S.
• Allen Dee Wang, DMD
• Amanda Mei Wang, MD
• Amelia J Wang, DMD

• Pediatrics Physician in Houston, TX
• Providers in Houston, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.