NPIMap

Individual provider Active NPI

Justin Hillary Timmons, FNP

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1093916017
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
678709 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701
Phone
(903) 606-4262
NPI assigned
May 29, 2007
Last updated
Sep 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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 678709 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701

Mailing address

PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000

Other practice location 1

507 Jacob St
Timpson, TX 75975-5255
Phone (936) 254-3338

Other identifiers 8

IdentifierTypeStateIssuer
8KU823OtherTXBCBS
194368005MedicaidTX
810717OtherTXMEDICARE
P02270214OtherTXMEDICARE RAIL ROAD
8KZ659OtherTXBCBS
P02270236OtherTXMEDICARE RAIL ROAD
194368010MedicaidTX
810736OtherTXMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080728000820 TX Practitioner - Nurse Practitioner 1658445499 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
May accept Medicare assignment
Group practices
Texas Quick Care LLCGroup PAC ID 0749585396, 7 clinicians

Practice addresses (Care Compare)

507 Jacob St
Timpson, TX 75975-5255
Phone (936) 254-3338

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
678709TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Quick Care, LLC CurrentSince Mar 1, 2016 Accepting new patients
Angelina Emergency Medicine Associates PA CurrentSince Jan 28, 2018 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Jul 22, 2019 Accepting new patients
Texas Quick Care, LLC CurrentSince Mar 1, 2016 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Jul 22, 2019 Accepting new patients
Panola Emergency Medicine Associates PA Past Accepting new patients
Texas Emergency Room Services PA Past Accepting new patients
Camino Real Emergency Physicians PLLC Past Accepting new patients

Locations

233 Hurst St
Center, TX 75935
Phone (936) 591-8171

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

505 S John Redditt Dr
Lufkin, TX 75904
Phone (713) 512-1200

310 Jacob St
Timpson, TX 75975
Phone (888) 315-9031

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13578/brand/1/csg/1/fhir/r4
  • Direct secure messaging: justin.timmons.1@13578.direct.athenahealth.com

Organizations & group practices 8

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 7

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": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1093916017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841656",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752841656",
            "telephone_number": "903-531-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-606-4262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "507 Jacob St",
            "address_purpose": "LOCATION",
            "city": "Timpson",
            "state": "TX",
            "postal_code": "759755255",
            "country_code": "US",
            "telephone_number": "936-254-3338",
            "fax_number": "936-257-3339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIMMONS",
        "first_name": "JUSTIN",
        "middle_name": "HILLARY",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-29",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "678709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8KU823",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194368005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "810717",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02270214",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8KZ659",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02270236",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194368010",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "810736",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.