Individual provider Active NPI

Jon Sampson Hitchcock, DO

  • Emergency Medicine Physician
  • Porter, TX
National Provider Identifier
1134502008
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
R3102 Issued in TX
Practice address
3339 Ashberry Falls LN
Porter, TX 77365-6689
Phone
(931) 212-4412
NPI assigned
Jul 9, 2015
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R0089 OK
Emergency Medicine Physician 207P00000X R3102 TX Primary

Addresses

Primary practice location

3339 Ashberry Falls LN
Porter, TX 77365-6689

Mailing address

3339 Ashberry Falls LN
Porter, TX 77365-6689
Phone (931) 212-4412

Other identifiers 1

IdentifierTypeStateIssuer
400512603MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170816002151 TX Practitioner - Emergency Medicine 3779861000 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lincoln Memorial University Medical Department, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hermann Hospital Based Physician GroupGroup PAC ID 4385075480, 272 clinicians

Practice addresses (Care Compare)

16100 S Fwy
Pearland, TX 77584-1895
Phone (713) 338-6565

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5995OKMDGeneral Practice Dentistry
R0089OKMDEmergency Medicine Physician
R3102TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hermann Hospital Based Physician Group Emergency Medicine CurrentSince Jul 1, 2020 Accepting new patients
Acs Primary Care Physicians Southwest, PA Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Memorial Hermann Health System Past Accepting new patients

Locations

27800 NW Freeway
Cypress, TX 77433
Phone (346) 231-4000

921 Gessner Rd
Houston, TX 77024
Phone (713) 242-3439

2555 Gulf Fwy S
League City, TX 77573
Phone (832) 932-9850

2555 Gulf Fwy S
#C1100
League City, TX 77573

2555 Gulf Fwy S
Ste C1100
League City, TX 77573
Phone (832) 932-9850

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

11800 Astoria Blvd
Pearland, TX 77089
Phone (281) 929-6100

16100 South Fwy
Pearland, TX 77584
Phone (713) 413-5000

9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300

9250 Pinecroft Dr
#C
Shenandoah, TX 77380

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

Hospital & facility affiliations 6

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": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1134502008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3339 ASHBERRY FALLS LN",
            "city": "PORTER",
            "state": "TX",
            "postal_code": "773656689",
            "telephone_number": "931-212-4412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3339 ASHBERRY FALLS LN",
            "city": "PORTER",
            "state": "TX",
            "postal_code": "773656689",
            "telephone_number": "931-212-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HITCHCOCK",
        "first_name": "JON",
        "middle_name": "SAMPSON",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-09",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "R0089",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "R3102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400512603",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Porter, TX

Sources for this page

Verify at the official NPI Registry.