Individual provider Active NPI

Frank Jesse Spates, OT

  • Occupational Therapist
  • Lake Jackson, TX
National Provider Identifier
1063603306
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
105144 Issued in TX
Practice address
135 Oyster Creek Dr Ste P
Lake Jackson, TX 77566-4118
Phone
(979) 480-1093
NPI assigned
Aug 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 105144 TX Primary

Addresses

Primary practice location

135 Oyster Creek Dr Ste P
Lake Jackson, TX 77566-4118

Mailing address

8902 Stephen F Austin Rd
Freeport, TX 77541-9781
Phone (972) 839-8507

Other identifiers 1

IdentifierTypeStateIssuer
4039315-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190522000352 TX Practitioner - Occupational Therapist in Private Practice 2163765793 Reassigns benefits to 1 organization
Practice locations: Freeport, TX

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perisseuo Group LLCGroup PAC ID 1254674880, 3 clinicians

Practice addresses (Care Compare)

491 This Way St
Lake Jackson, TX 77566-5144
Phone (979) 480-1093

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105144TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Perisseuo Group LLC CurrentSince Dec 3, 2018 Accepting new patients
Perisseuo Group LLC CurrentSince Aug 29, 2021 Accepting new patients

Locations

491 This Way St
Lake Jackson, TX 77566
Phone (979) 480-1093

135 Oyster Creek Dr
Ste P
Lake Jackson, TX 77566
Phone (281) 943-9997

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1063603306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8902 STEPHEN F AUSTIN RD",
            "city": "FREEPORT",
            "state": "TX",
            "postal_code": "775419781",
            "telephone_number": "972-839-8507",
            "fax_number": "979-429-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 OYSTER CREEK DR STE P",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775664118",
            "telephone_number": "979-480-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPATES",
        "first_name": "FRANK",
        "middle_name": "JESSE",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-01",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "105144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4039315-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.