Gary Wayne Jackson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02551 Issued in TX

Practice address

1804 College Ave
Levelland, TX 79336-6507

Phone

(806) 894-3141

Fax

(806) 894-7094

NPI assigned

Jul 2, 2007

Last updated

Dec 1, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Methodist Hospital LevellandGroup PAC ID 8527041037, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Covenant Hospital Levelland Hospital, Levelland, TX, CCN 450755

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Methodist Hospital Levelland

  dba Covenant Hospital Levelland

  • Emergency Medicine Physician
  • Levelland, TX
  • NPI 1043328222
  Medicare reassignment Care Compare group NPD
• Methodist Hospital Levelland

  dba Covenant Levelland EMS

  • Ambulance
  • Levelland, TX
  • NPI 1780219097
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Methodist Hospital Levelland

  dba Covenant Hospital Levelland

  • General Acute Care Hospital
  • Levelland, TX
  • NPI 1225146400
  Care Compare affiliation
• Methodist Hospital Levelland

  dba Covenant Levelland EMS

  • Ambulance
  • Levelland, TX
  • NPI 1780219097

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228089600000",
    "number": "1154528263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 S. COLLEGE AVE",
            "city": "LEVELLAND",
            "state": "TX",
            "postal_code": "79336",
            "telephone_number": "806-864-3141",
            "fax_number": "806-894-7094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 COLLEGE AVE",
            "city": "LEVELLAND",
            "state": "TX",
            "postal_code": "793366507",
            "telephone_number": "806-894-3141",
            "fax_number": "806-894-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "GARY",
        "middle_name": "WAYNE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2008-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christie Holder, N.P.
• Betty J Holliday, R.N.
• Leslie Carol Hounshell, M.S., CCC-SLP
• Michelle Howell, RNC
• Charles Von Oden Hughes III, MD
• Ashley Arden Johnson, LVN
• James Joseph Kainer, LPC
• Aseel Karadi, DMD
• Jeannie Keen
• Alyssa Janette Kern

• Physician Assistant in Levelland, TX
• Providers in Levelland, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.