NPIMap

Organization Active NPI

Winnsboro Health Services PLLC

  • Internal Medicine Physician
  • Winnsboro, TX
National Provider Identifier
1154717536
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M7519 Issued in TX
Legal business name
WINNSBORO HEALTH SERVICES PLLC
Practice address
209 E Broadway St
Winnsboro, TX 75494-2604
Phone
(903) 342-3355
Fax
(903) 342-3350
NPI assigned
Apr 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Authorized official

Name
Dr. Jared Bradford Petty, DONPI 1720280753
Title
Physician, Authorized Member
Phone
(903) 342-3355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X M7519 TX Primary

Addresses

Primary practice location

209 E Broadway St
Winnsboro, TX 75494-2604

Mailing address

209 E Broadway St
Winnsboro, TX 75494-2604
Phone (903) 342-3355

Other names 1

  • Winnsboro Internal Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150626001660 TX Part B Supplier - Clinic/Group Practice 2668784083 Receives reassigned benefits from 21 practitioners
Practice locations: Winnsboro, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2097909Winnsboro Health Services, PLLC209 E Broadway, Winnsboro, TX 75494Certificate of waiverJun 24, 2027

National Provider Directory

National Provider Directory

Locations

209 E Broadway St
Winnsboro, TX 75494
Phone (903) 342-3355

901 S Beech St
Winnsboro, TX 75494
Phone (903) 342-3355

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11327/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1428796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1154717536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 E BROADWAY ST",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754942604",
            "telephone_number": "903-342-3355",
            "fax_number": "903-342-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 E BROADWAY ST",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754942604",
            "telephone_number": "903-342-3355",
            "fax_number": "903-342-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINNSBORO HEALTH SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-12",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "BRADFORD",
        "authorized_official_title_or_position": "PHYSICIAN, AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "903-342-3355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M7519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winnsboro Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winnsboro, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.