Jacqueline Celeste Evans, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0101266493 Issued in VA

Practice address

3551 Roger Brooke Dr # 3600
Fort Sam Houston, TX 78234

Phone

(210) 916-6129

NPI assigned

May 20, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment NPD
• Emergency Medicine Services of TX, PLLC

  • Emergency Medicine Physician
  • San Antonio, TX
  • NPI 1245938729
  Medicare reassignment NPD
• Third Coast Emergency Physicians Southwest PA

  • Emergency Medicine Physician
  • San Antonio, TX
  • NPI 1497793475
  Medicare reassignment NPD
• Travis County Emergency Physicians PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1962440933
  Medicare reassignment NPD

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1154733582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR # 3600",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR # 3600",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "210-916-6129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1060 W Perimeter Rd",
            "address_purpose": "LOCATION",
            "city": "Jb Andrews",
            "state": "MD",
            "postal_code": "207626602",
            "country_code": "US",
            "telephone_number": "240-857-2333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1060 W Perimeter Rd",
            "address_purpose": "LOCATION",
            "city": "Jb Andrews",
            "state": "MD",
            "postal_code": "207626602",
            "country_code": "US",
            "telephone_number": "240-857-2333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 S Ih 35",
            "address_purpose": "LOCATION",
            "city": "Pearsall",
            "state": "TX",
            "postal_code": "780616601",
            "country_code": "US",
            "telephone_number": "830-334-3617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "JACQUELINE",
        "middle_name": "CELESTE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-20",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NE",
            "license": "28928",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "S4757",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101266493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Norma Alicia Erosa, PHD
• Torri Espinoza-Logan, RDH
• Luis Enrique Espinoza, MD
• Rebecca Jo Espinoza, OTR
• Peter V Espitia, P.A.
• Osceola M Evans, MSW
• Tommy Ray Evans, RN CASE MANAGER
• Shannon Faber, M.D.
• Babajide Fagbemi, PHARM.D
• Erin P. Fahy, APRN

• Emergency Medicine Physician in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.