Jacob Daniel Ethridge, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA12348 Issued in TX

Practice address

1150 N Loop 1604 W Ste 150
San Antonio, TX 78248-4505

Phone

(281) 783-8162

Fax

(713) 439-7995

NPI assigned

Sep 28, 2018

Last updated

Jun 29, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nluc PLLCGroup PAC ID 3072752302, 219 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nluc PLLC

  • Urgent Care Clinic/Center
  • Houston, TX
  • NPI 1518209113
  Medicare reassignment Care Compare group NPD
• Carlos Porter, MD PA

  dba Satmed

  • Non-Surgical Family Planning Clinic/Center
  • Universal City, TX
  • NPI 1548475320
  NPD
• Carlos Porter, MD PA

  dba Porter Medical Associates

  • Primary Care Clinic/Center
  • San Antonio, TX
  • NPI 1558400168
  NPD
• Nluc PLLC

  dba Next Level Urgent Care-League City

  • Urgent Care Clinic/Center
  • League City, TX
  • NPI 1043814049
  NPD
• Nluc PLLC Dba Next Level Urgent Care

  dba Next Level Urgent Care

  • Urgent Care Clinic/Center
  • Conroe, TX
  • NPI 1023529765
  NPD (past)

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1104301852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 BRIARPARK DR STE 575",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770423776",
            "telephone_number": "832-626-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N LOOP 1604 W STE 150",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782484505",
            "telephone_number": "281-783-8162",
            "fax_number": "713-439-7995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10423 State Highway 151 Ste 101",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782514768",
            "country_code": "US",
            "telephone_number": "210-341-9614",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5282 Medical Dr Ste 250",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782296039",
            "country_code": "US",
            "telephone_number": "210-341-9614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "JACOB",
        "middle_name": "DANIEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-28",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "TEMPORARY",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leighton Etchieson
• Douglas Etchison
• Pamela F Etchison, D.D.S.
• Ethos Eldercare LLC
• Jacob Ethridge
• Natalie Diane Ethridge, CPNP-AC
• Naika Etienne
• John E. Etlinger, M.D.
• Walter Mitini Etoh, NURSE PRACTITIONER
• Kenneth Oshiokhayamhe Etokhana, M.D

• Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.