Active NPI
Rakesh Jain, MD
- Psychiatry Physician
- Lake Jackson, TX
National Provider Identifier
1124221304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- J0540
- Practice address
- 461 This Way St
Lake Jackson, TX 77566-5143 - Phone
- (979) 480-9886
- Fax
- (979) 480-9997
- NPI assigned
- Jun 6, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | J0540 | TX | Primary |
Addresses
Primary practice location
461 This Way St
Lake Jackson, TX 77566-5143
Mailing address
19 Heritage Oak CT
Lake Jackson, TX 77566-4961
Phone (979) 480-9886
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y0079715 | Other | TX | DEPT OF PUBLIC SAFETY |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J0540 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1124221304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 HERITAGE OAK CT",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775664961",
"telephone_number": "979-480-9886",
"fax_number": "979-480-9997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "461 THIS WAY ST",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775665143",
"telephone_number": "979-480-9886",
"fax_number": "979-480-9997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAIN",
"first_name": "RAKESH",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-06",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "J0540",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF PUBLIC SAFETY",
"identifier": "Y0079715",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Jackson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.