NPIMap

Individual provider Active NPI

Jason Kelley Tibbels, MD

  • Family Medicine Physician
  • Decatur, TX
National Provider Identifier
1215904222
Registry record updated Aug 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L5154 Issued in TX
Practice address
2250 S FM 51 Ste 400
Decatur, TX 76234-3767
Phone
(640) 627-1011
NPI assigned
Mar 8, 2006
Last updated
Aug 17, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L5154 TX Primary

Addresses

Primary practice location

2250 S FM 51 Ste 400
Decatur, TX 76234-3767

Mailing address

2250 S FM 51 Ste 400
Decatur, TX 76234-3767
Phone (640) 627-1011

Other identifiers 1

IdentifierTypeStateIssuer
156092202MedicaidTX

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
I20160330002291 TX Practitioner - Family Practice 0941285654 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L5154TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Denton Texas Health Management, PLLC Family Medicine CurrentSince Feb 13, 2016 Accepting new patients
Jack County Hospital District Family Medicine CurrentSince Mar 16, 2023 Accepting new patients
Jack County Hospital District CurrentSince Mar 16, 2023 Accepting new patients
West Wharton County Hospital District Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients
Denton I Enterprises, L.L.C. Past Accepting new patients
Decatur Hospital Authority Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients
Pilot Point Care Center Past Accepting new patients
Fannin County Hospital Authority Past Accepting new patients

Locations

1501 N Elm St
Denton, TX 76201
Phone (940) 387-0019

215 Chisholm Trl
Jacksboro, TX 76458
Phone (940) 567-5528

Interoperability endpoints

  • Direct secure messaging: jason.tibbels.1@11284.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Longmeadow Healthcare CenterJustin, TX, CCN 675185 Skilled nursing facility Adp of the SNF Apr 13, 2025
Avir at Pilot PointPilot Point, TX, CCN 675902 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2025
Mar 1, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282003200000",
    "number": "1215904222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 S FM 51 STE 400",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343767",
            "telephone_number": "640-627-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 S FM 51 STE 400",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343767",
            "telephone_number": "640-627-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBELS",
        "first_name": "JASON",
        "middle_name": "KELLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2010-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L5154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156092202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, TX

Sources for this page

Verify at the official NPI Registry.