Individual provider Active NPI

Lena Jacob, PA-C

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1104214402
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA09496 Issued in TX
Practice address
2280 Inwood Rd
Dallas, TX 75390-4009
Phone
(214) 645-8525
NPI assigned
Jan 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X PA09496 TX
Physician Assistant 363A00000X PA09496 TX Primary

Addresses

Primary practice location

2280 Inwood Rd
Dallas, TX 75390-4009

Mailing address

5323 Harry Hines Blvd
Dallas, TX 75390-7201
Phone (214) 645-8525

Other practice location 1

1515 Holcombe Blvd
Houston, TX 77030-4009
Phone (713) 792-6161

Other practice location 2

5323 Harry Hines Blvd
Dallas, TX 75390-4009
Phone (214) 645-8525

Other identifiers 2

IdentifierTypeStateIssuer
8844NUOtherTXBCBS
355290301MedicaidTX

Other names 1

  • Lena Abraham 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
I20150206000281 TX Practitioner - Physician Assistant 9133444565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2280 Inwood Rd
Dallas, TX 75235-7321
Phone (214) 645-8300

5201 Harry Hines Blvd
Dallas, TX 75235-7708
Phone (214) 590-5582

5201 Harry Hines VLVD
Dallas, TX 75235-7708
Phone (214) 590-5582

5323 Harry Hines Blvd
Dallas, TX 75390-9257

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA09496TXMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Radiation Oncology CurrentSince Sep 1, 2024 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Sep 1, 2024 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 3

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 1

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": "1420675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1104214402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5323 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753907201",
            "telephone_number": "214-645-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2280 INWOOD RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753904009",
            "telephone_number": "214-645-8525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 Holcombe Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770304009",
            "country_code": "US",
            "telephone_number": "713-792-6161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5323 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753904009",
            "country_code": "US",
            "telephone_number": "214-645-8525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "LENA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-08",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "TX",
            "license": "PA09496",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8844NU",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355290301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LENA",
            "last_name": "ABRAHAM",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.