James Kerbacher, MD
Individual provider Active NPI Family Medicine Physician · Fairfield, TX
NPI 1154360766 · NPPES record last updated Jun 1, 2011
Key facts
- NPI
- 1154360766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- L3713 (TX)
- Practice address
- 764 W Commerce St
Fairfield, TX 75840-1428 - Phone
- (903) 389-2181
- Fax
- (903) 389-0901
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180305000118 | WA | Practitioner - Family Practice | 5597833483 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3713 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sea Mar Community Health Centers | Family Medicine | Current |
Accepting new patients |
| Sea Mar Community Health Centers | Current |
Accepting new patients | |
| Sea Mar Community Health Centers | Family Medicine | Current | Accepting new patients |
Locations
1400 N Laventure Rd
Mount Vernon, WA 98273
Phone (360) 428-4075
597 Point Brown Ave NW
Ocean Shores, WA 98569
Phone (360) 289-2427
3030 Limited Ln NW
Olympia, WA 98502
Phone (360) 352-6000
8720 14th Ave S
Seattle, WA 98108
Phone (206) 762-3730
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L3713 | TX | Yes |
Addresses
Primary practice location
764 W Commerce St
Fairfield, TX 75840-1428
Mailing address
PO Box 9477
Tyler, TX 75711-9477
Phone (903) 594-2450
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1495368-02 | Medicaid | TX | |
| 80195007 | Other | MEDICARE RR |
Other providers in Fairfield, TX
- HCC of Fairfield LLC
- Hearts of Gladys We Care LLC
- Hometown Pharmacy
- Geneva Elaine Honeycutt
- Carl Andrew Johnson
- David Allen Latham
- Beverly Levels
- Liberty County Hospital District No. 1
- Katrina Logan
- Madison Rose Lopez
All providers in Fairfield, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.