Mahalia L Jackson-Butler, DNP, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

AP117597 Issued in TX

Practice address

2721 Central Dr
Bedford, TX 76021-4810

Phone

(214) 277-2243

Fax

(214) 231-2926

NPI assigned

Aug 22, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Mrs. Mahalia L Jackson Former name

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

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medi- Elite, PCGroup PAC ID 0648594309, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Medi- Elite, PC

  • Primary Care Clinic/Center
  • Bedford, TX
  • NPI 1528330792
  Medicare reassignment Care Compare group Authorized official
• Segue Health of Texas PLLC

  • Family Medicine Physician
  • Azle, TX
  • NPI 1215510763
  Medicare reassignment NPD
• Total MD Physicians Group, PLLC

  dba Total Behavioral Health

  • Family Medicine Physician
  • Austin, TX
  • NPI 1982031852
  Medicare reassignment NPD
• DFW Super Group I LLC

  • Nurse Practitioner
  • Plano, TX
  • NPI 1275575755
  NPD (past)

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1063669893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4621 S COOPER ST STE 131-717",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760175866",
            "telephone_number": "214-277-2243",
            "fax_number": "214-231-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2721 CENTRAL DR",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760214810",
            "telephone_number": "214-277-2243",
            "fax_number": "214-231-2926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-BUTLER",
        "first_name": "MAHALIA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-22",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "715590",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP117597",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP117597",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP117597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201844201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAHALIA",
            "last_name": "JACKSON",
            "middle_name": "L",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ali Ishaque, M.D
• Nina Veniaminovna Ivanova
• J. D. Bell, M.D., P.a.
• Ommara Shereen Jabbar, MD
• Jack Jones Hearing Centers, Inc. (AudioNova)
• Antonious Dewayne Jackson, D.C., F.N.P-C
• Ryan C Jackson, MD
• Sharon L Jackson, MD
• Stacey Jackson, FNP-C
• Tinu Elsa Jacob, RPH

• Primary Care Nurse Practitioner in Bedford, TX
• Providers in Bedford, TX by specialty
• Primary Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.