Jerry Liles, D.O.

Key facts

NPI

1013934645

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

F1749 (TX)

Practice address

1009 E 6TH St
Alice, TX 78332-4657

Phone

(361) 668-8888

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

Organizations & group practices 8

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.

• Conviva Medical Center Management of Texas, P.a. Internal Medicine Physician · Live Oak, TX · NPI 1770988990
  Medicare reassignment Care Compare group NPD FAMILY MEDICINE · TX
• Centerwell Senior Primary Care (SC) PC Internal Medicine Physician · Anderson, SC · NPI 1710341144
  Care Compare group
• Rabagos Health Care PLLC Family Medicine Physician · Kingsville, TX · NPI 1689924904
  NPD FAMILY MEDICINE
• Centerwell Senior Primary Care (SC) PC Internal Medicine Physician · Greenville, SC · NPI 1376907790
  NPD FAMILY MEDICINE
• Abk Emergency Physicians PLLC Emergency Medicine Physician · Alice, TX · NPI 1801983036
  NPD (past)
• Bayside Emergency Physicians, LLP Emergency Medicine Physician · Alice, TX · NPI 1720013964
  NPD (past)
• Bayside Emergency Pyhsicians, LLP Emergency Medicine Physician · Beeville, TX · NPI 1174558324
  NPD (past)
• Texas Em-I Medical Services, PA Internal Medicine Physician · Greenville, TX · NPI 1699981720
  NPD (past)

Hospital & facility affiliations 1

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

• NSCL Inc Home Health Agency · Benavides, TX · NPI 1053404236
  Care Compare affiliation Home health agency

Medicare Care Compare profile

Specialty

Family Practice
Also: Emergency Medicine

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Conviva Medical Center Management of Texas, P.a. (146 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Nursing Services and Consultants of Laredo Home health agency · Laredo, TX · CCN 677735

Medicare participation

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles (7 of 8)

Locations

Networks

• TX HMO

Interoperability endpoints

• Direct secure messaging: jerry.liles.1@29601.direct.athenahealth.com

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 16, 2021.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1013934645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331262051",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 E 6TH ST",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783324657",
            "telephone_number": "361-668-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILES",
        "first_name": "JERRY",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F1749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jerry.liles@conviva.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1009 E 6TH ST",
            "city": "ALICE",
            "state": "TX",
            "country_code": "US",
            "postal_code": "783324657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in Alice, TX · Family Medicine Physician in Texas