NPIMap

Organization Active NPI

Ear Institute of Texas P a

  • Specialist
  • San Antonio, TX
National Provider Identifier
1093846248
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
L5777 Issued in TX
Legal business name
EAR INSTITUTE OF TEXAS P A
Practice address
18518 Hardy Oak Blvd
Suite 300
San Antonio, TX 78258-4271
Phone
(210) 696-4327
Fax
(210) 798-2509
NPI assigned
Mar 8, 2007
Last updated
Feb 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Authorized official

Name
Dr. Lance E Jackson, MDNPI 1174554521
Title
Owner
Phone
(210) 696-4327

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X L5777 TX Primary

Addresses

Primary practice location

18518 Hardy Oak Blvd
Suite 300
San Antonio, TX 78258-4271

Mailing address

18518 Hardy Oak Blvd
Suite 300
San Antonio, TX 78258-4271
Phone (210) 696-4327

Other identifiers 3

IdentifierTypeStateIssuer
0036JVOtherTXBLUE SHIELD
P00019999OtherTXMEDICARE RAILROAD
157517701MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070413000218 TX Part B Supplier - Clinic/Group Practice 5991800310 Receives reassigned benefits from 11 practitioners
Practice locations: San Antonio, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0500248Ear Institute of Texas, the18518 Hardy Oak Blvd, Suite 300, San Antonio, TX 78258Provider-performed microscopyJan 29, 2027

National Provider Directory

National Provider Directory

Locations

18518 Hardy Oak Blvd
Ste 300
San Antonio, TX 78258
Phone (210) 696-4327

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1093846248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18518 HARDY OAK BLVD",
            "address_2": "SUITE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584271",
            "telephone_number": "210-696-4327",
            "fax_number": "210-798-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18518 HARDY OAK BLVD",
            "address_2": "SUITE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584271",
            "telephone_number": "210-696-4327",
            "fax_number": "210-798-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR INSTITUTE OF TEXAS P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-696-4327",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "L5777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0036JV",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00019999",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157517701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.