Gary Wayne Jackson, PA
Individual provider Active NPI Physician Assistant · Levelland, TX
NPI 1154528263 · NPPES record last updated Dec 1, 2008
Key facts
- NPI
- 1154528263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA02551 (TX)
- Practice address
- 1804 College Ave
Levelland, TX 79336-6507 - Phone
- (806) 894-3141
- Fax
- (806) 894-7094
- NPI assigned
- Jul 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Methodist Hospital Levelland
Practice addresses (Care Compare)
1900 College Ave
Levelland, TX 79336-6508
Phone (806) 894-4963
Hospital & facility affiliations
- Covenant Hospital Levelland
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170612001980 | TX | Practitioner - Physician Assistant | 6406097930 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Methodist Hospital Levelland | Current |
Accepting new patients | |
| Methodist Hospital Levelland | Current |
Accepting new patients |
Locations
1804 College Ave
Levelland, TX 79336
Phone (806) 894-3141
103 John Dupree Dr
Levelland, TX 79336
Phone (806) 894-2465
1900 College Ave
Levelland, TX 79336
Phone (806) 894-3141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA02551 | TX | Yes |
Addresses
Primary practice location
1804 College Ave
Levelland, TX 79336-6507
Mailing address
1805 S. College Ave
Levelland, TX 79336
Phone (806) 864-3141
Other providers in Levelland, TX
- Christie Holder
- Betty J Holliday
- Leslie Carol Hounshell
- Michelle Howell
- Charles Von Oden Hughes III
- Ashley Arden Johnson
- James Joseph Kainer
- Aseel Karadi
- Jeannie Keen
- Alyssa Janette Kern
All providers in Levelland, TX · Physician Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2008. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.