Individual provider Active NPI

Jeffrey S Pilette, FNP

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1033155270
Registry record updated Aug 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
647632 Issued in TX
Practice address
1910 Roseland Blvd
Tyler, TX 75701-4246
Phone
(903) 533-0644
Fax
(903) 533-0441
NPI assigned
Jun 22, 2006
Last updated
Aug 12, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 647632 TX Primary

Addresses

Primary practice location

1910 Roseland Blvd
Tyler, TX 75701-4246

Mailing address

1910 Roseland Blvd
Tyler, TX 75701-4246
Phone (903) 533-0644

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
I20040129000501 TX Practitioner - Nurse Practitioner 1850294653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ault McInnis PLLCGroup PAC ID 9133396674, 7 clinicians

Practice addresses (Care Compare)

2114 E Rusk St
Jacksonville, TX 75766-9052
Phone (903) 284-6105

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
647632TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family First Urgent Care PLLC CurrentSince Mar 1, 2014 Accepting new patients
Ault McInnis PLLC CurrentSince Apr 2, 2013 Accepting new patients

Locations

2114 E Rusk St
Jacksonville, TX 75766
Phone (903) 284-6105

Organizations & group practices 2

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 3

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1033155270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 ROSELAND BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757014246",
            "telephone_number": "903-533-0644",
            "fax_number": "903-533-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 ROSELAND BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757014246",
            "telephone_number": "903-533-0644",
            "fax_number": "903-533-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PILETTE",
        "first_name": "JEFFREY",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "647632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.