Active NPI
Nikolaos Kombos, PHD
- Clinical Psychologist
- Jacksonville, TX
National Provider Identifier
1194757930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3642
- Practice address
- 208 E Rusk St
Jacksonville, TX 75766-4942 - Phone
- (903) 262-6175
- Fax
- (903) 543-9311
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3642 | TX | Primary |
Addresses
Primary practice location
208 E Rusk St
Jacksonville, TX 75766-4942
Mailing address
PO Box 2621
Jacksonville, TX 75766-4942
Phone (903) 262-6175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
208 E Rusk St
Jacksonville, TX 75766-4942
Phone (903) 262-6175
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3642 | TX | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Psychological Consulting LLC | Current | Accepting new patients | |
| Health and Human Services Commission | Clinical | Past | Accepting new patients |
Locations
208 E Rusk St
Jacksonville, TX 75766
Phone (903) 262-6175
Organizations & group practices 2
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.
-
- Psychologist
- Jacksonville, TX
- NPI 1164703047
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305763200000",
"number": "1194757930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2621",
"city": "JACKSONVILLE",
"state": "TX",
"postal_code": "757664942",
"telephone_number": "903-262-6175",
"fax_number": "903-534-9311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 E RUSK ST",
"city": "JACKSONVILLE",
"state": "TX",
"postal_code": "757664942",
"telephone_number": "903-262-6175",
"fax_number": "903-543-9311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMBOS",
"first_name": "NIKOLAOS",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2011-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "3642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; 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.