Individual provider Active NPI

Gina G Jones, PA-C

  • Physician Assistant
  • Bedford, TX
National Provider Identifier
1043387731
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04954 Issued in TX
Practice address
2425 Hwy 121
Bedford, TX 76021-5011
Phone
(817) 540-4477
Fax
(817) 510-0188
NPI assigned
Nov 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

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 1074241 TX
Physician Assistant 363A00000X PA04954 TX Primary

Addresses

Primary practice location

2425 Hwy 121
Bedford, TX 76021-5011

Mailing address

728 Johns Well CT
Argyle, TX 76226-1729
Phone (386) 547-0975

Other names 1

  • Miss Gina Maria Guillem Former name

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
I20070502000369 TX Practitioner - Physician Assistant 9638275993 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1545 E Southlake Blvd
Southlake, TX 76092-6422
Phone (817) 748-8700

5400 Clearfork Main St
Fort Worth, TX 76109-3500
Phone (817) 433-7000

Hospital & facility affiliations

  • Texas Health Presbyterian Hospital Flower Mound Hospital, Flower Mound, TX, CCN 670068
  • Texas Health Harris Methodist Hospital Southwest F Hospital, Fort Worth, TX, CCN 450779
  • Texas Health Harris Methodist Hospital Southlake Hospital, Southlake, TX, CCN 450888
  • Carrollton Regional Medical Center Hospital, Carrollton, TX, CCN 450730

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1074241TXMDPhysician Assistant
PA04954TXMDPhysician Assistant

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1043387731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 JOHNS WELL CT",
            "city": "ARGYLE",
            "state": "TX",
            "postal_code": "762261729",
            "telephone_number": "386-547-0975",
            "fax_number": "254-267-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 HWY 121",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760215011",
            "telephone_number": "817-540-4477",
            "fax_number": "817-510-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "GINA",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "1074241",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "GUILLEM",
            "middle_name": "MARIA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bedford, TX

Sources for this page

Verify at the official NPI Registry.