Active NPI
James J Maynard, M.D.
- Child & Adolescent Psychiatry Physician
- Austin, TX
National Provider Identifier
1104836808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- G5347
- Practice address
- 500 Grace Lane
Austin, TX 78746 - Phone
- (512) 343-6067
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | G5347 | TX | Primary |
Addresses
Primary practice location
500 Grace Lane
Austin, TX 78746
Mailing address
500 Grace LN
Austin, TX 78746-4815
Phone (512) 343-6067
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A36U | Other | TX | BLUE CROSS BLUE SHIELD |
| P000A36U4 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110913000080 | TX | Practitioner - Psychiatry | 9739350398 | Practice locations: Austin, TX |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727913600000",
"number": "1104836808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 GRACE LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787464815",
"telephone_number": "512-343-6067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 GRACE LANE",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78746",
"telephone_number": "512-343-6067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYNARD",
"first_name": "JAMES",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2024-10-03",
"certification_date": "2024-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "TX",
"license": "G5347",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "A36U",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P000A36U4",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.