Individual provider Active NPI

Jayma Mickler, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1013420827
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11622 Issued in TX
Practice address
1500 S Main St FL 10
Fort Worth, TX 76104-4917
Phone
(817) 702-4151
NPI assigned
Nov 15, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11622 TX Primary

Addresses

Primary practice location

1500 S Main St FL 10
Fort Worth, TX 76104-4917

Mailing address

6301 Almeda Rd Apt 512
Houston, TX 77021-1059

Other practice location 1

12234 Shadow Creek Pkwy Ste 104
Pearland, TX 77584-7330
Phone (713) 429-5325

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190501002404 TX Practitioner - Physician Assistant 0042572265 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Texas Tech University Health Science Center School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Seema Kazi MD PAGroup PAC ID 5193040772, 22 clinicians

Practice addresses (Care Compare)

200 Westpark Way
Euless, TX 76040-3963
Phone (817) 488-8998

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA11622TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kairos Medical LLC Past Accepting new patients
United Psychiatry Institute, LLC PastSince Jun 1, 2023 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DEBFAD

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1013420827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 ALMEDA RD APT 512",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770211059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST FL 10",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-4151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12234 Shadow Creek Pkwy Ste 104",
            "address_purpose": "LOCATION",
            "city": "Pearland",
            "state": "TX",
            "postal_code": "775847330",
            "country_code": "US",
            "telephone_number": "713-429-5325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKLER",
        "first_name": "JAYMA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-15",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.