NPIMap

Individual provider Active NPI

Jacalyn C Siver, P.A.-C

  • Physician Assistant
  • Lake Jackson, TX
National Provider Identifier
1013912609
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA05248 Issued in TX
Practice address
219 Oak Dr S Ste a
Lake Jackson, TX 77566-5675
Phone
(979) 297-4033
NPI assigned
Jun 20, 2005
Last updated
Feb 21, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 359 SD
Physician Assistant 363A00000X PA05248 TX Primary

Addresses

Primary practice location

219 Oak Dr S Ste a
Lake Jackson, TX 77566-5675

Mailing address

633 Walnut St
Lake Jackson, TX 77566-5747
Phone (361) 484-6243

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140204001364 TX Practitioner - Physician Assistant 1355570805 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Houston Regional Gastroenterology Institute PLLCGroup PAC ID 9436417672, 37 clinicians
Primary Care Associates of Lake Jackson PLLCGroup PAC ID 1951623222, 2 clinicians
Gulf Coast Gastroenterology, PAGroup PAC ID 6608882857, 2 clinicians

Practice addresses (Care Compare)

15555 Creek Bend Dr
Suite 200
Sugar Land, TX 77478-4670
Phone (832) 707-5978

219 Oak Dr S
A
Lake Jackson, TX 77566-5675
Phone (979) 297-4033

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA05248TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
PRMC ER Group Inc Past Accepting new patients
Grapevine Emergency Physicians PLLC Physician Assistant Past Accepting new patients
Paris Trail Emergency Physicians PLLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jsiver458439@direct.stlukeshealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1013912609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 WALNUT ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665747",
            "telephone_number": "361-484-6243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 OAK DR S STE A",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665675",
            "telephone_number": "979-297-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVER",
        "first_name": "JACALYN",
        "middle_name": "C",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "359",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

Verify at the official NPI Registry.