Jae-Koo An, M.D.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

L5652 Issued in TX

Practice address

7000 W Plano Pkwy Ste 110
Plano, TX 75093-8467

Phone

(972) 306-3767

Fax

(972) 566-8839

NPI assigned

Mar 17, 2006

Last updated

Sep 25, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Irving, TX
  • NPI 1053397331
  Medicare reassignment NPD
• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Southlake, TX
  • NPI 1649256546
  NPD
• Texas Digestive Disease Consultants PLLC

  • Gastroenterology Physician
  • Covington, LA
  • NPI 1295428415
  NPD
• Legacy Trail Surgery Center, LLC

  dba Live Oak Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Plano, TX
  • NPI 1518486091
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1205805447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7610 N STEMMONS FWY STE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752474228",
            "telephone_number": "214-689-5960",
            "fax_number": "469-713-8084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 W PLANO PKWY STE 110",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938467",
            "telephone_number": "972-306-3767",
            "fax_number": "972-566-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AN",
        "first_name": "JAE-KOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "TX",
            "license": "L5652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8G9571",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Notley Amos, PH.D.
• Chad Martin Amosson, MD
• Ampic Rehab, PLLC (Ampic Physical Therapy)
• Abiola Amure, FNP-C
• Amy Beth Hopkins MPT PC Dba Your Personal Best PT (Your Personal Best PT)
• Aashish Anand, M.D
• Anayer Medical PA
• Anchor of Hope Hospice LLC
• Lauren Alina Ancona, M.S. CCC-SLP
• Bridgett Anderson-Wright, DNP, APRN, FNP-C

• Pediatric Gastroenterology Physician in Plano, TX
• Providers in Plano, TX by specialty
• Pediatric Gastroenterology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; 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.