NPIMap

Individual provider Active NPI

Jeffory Ford Thomas, MD

  • Adult Medicine Physician
  • Texarkana, TX
National Provider Identifier
1174502991
Registry record updated Jun 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
K0219 Issued in TX
Practice address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone
(903) 614-3000
Fax
(903) 614-3525
NPI assigned
Jan 11, 2006
Last updated
Jun 21, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X K0219 TX Primary

Addresses

Primary practice location

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766

Mailing address

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Other identifiers 3

IdentifierTypeStateIssuer
97654OtherARBLUE CROSS BLUE SHIELD
0051MHOtherTXBLUE CROSS BLUE SHIELD
131978001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041026000967 TX Practitioner - Family Practice 6901886100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association CurrentSince Jul 13, 2010 Accepting new patients
Collom & Carney Clinic Association CurrentSince Jul 13, 2010 Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
Fannin County Hospital Authority Past Accepting new patients
Collom and Carney Clinic Association Past Accepting new patients
Encompass Health Rehabilitation Hospital of Texarkana, Inc. Past Accepting new patients
Schindler-Smith PA Adult Medicine Past Accepting new patients
Fannin County Hospital Authority Past Accepting new patients
Collom and Carney Clinic Association Past Accepting new patients

Locations

1000 Pine St
Texarkana, TX 75501
Phone (903) 798-7365

2014 Galleria Oaks Dr
Texarkana, TX 75503
Phone (903) 792-2990

2931 Richmond Rd
Texarkana, TX 75503
Phone (903) 614-3200

5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone (903) 614-3008

515 W 12th St
Texarkana, TX 75501
Phone (903) 735-5000

815 N Kings Hwy
Wake Village, TX 75501
Phone (903) 614-3700

Interoperability endpoints

  • Direct secure messaging: jeffory.thomas.p1@direct.collom-carney.nextgenshare.com

Organizations & group practices 12

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1174502991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JEFFORY",
        "middle_name": "FORD",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "K0219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "97654",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0051MH",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131978001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.