Active NPI
Jack C. Tips, PH.D., C.C.N.
- Nutrition Education Nutritionist
- Austin, TX
National Provider Identifier
1104948041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Education Nutritionist
- License
- 0017161
- Practice address
- 9419 Westminster Glen
Austin, TX 78730 - Phone
- (512) 328-3996
- Fax
- (512) 263-7787
- NPI assigned
- Apr 4, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | 0017161 | NY | Primary |
| Registered Dietetic Technician | 136A00000X | 0017161 | NY |
Addresses
Primary practice location
9419 Westminster Glen
Austin, TX 78730
Mailing address
9419 Prince William
Austin, TX 78730
Phone (512) 328-3996
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0017161 | NY | MD | Registered Dietetic Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444953600000",
"number": "1104948041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9419 PRINCE WILLIAM",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78730",
"telephone_number": "512-328-3996",
"fax_number": "512-263-7787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9419 WESTMINSTER GLEN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78730",
"telephone_number": "512-328-3996",
"fax_number": "512-263-7787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIPS",
"first_name": "JACK",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "PH.D., C.C.N.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2015-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "NY",
"license": "0017161",
"primary": true
},
{
"code": "136A00000X",
"taxonomy_group": "",
"desc": "Dietetic Technician, Registered",
"state": "NY",
"license": "0017161",
"primary": false
}
],
"identifiers": [],
"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 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.