Jaiswal Clinic PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

JAISWAL CLINIC PLLC

Practice address

702 Bryan Dr
Suite 100
Durant, OK 74701-7031

Phone

(580) 924-4704

Fax

(580) 924-6001

NPI assigned

May 27, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Deepak S Jaiswal, MDNPI 1386698728

Title

Owner

Phone

(580) 924-4704

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FEIEAA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deepak S. Jaiswal, M.D.

  • Internal Medicine Physician
  • Durant, OK
  • NPI 1386698728
  Medicare reassignment Care Compare group NPD Authorized official
• Angela Renee Wright, ARNP-CNP

  • Primary Care Nurse Practitioner
  • Durant, OK
  • NPI 1043443062

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1225296361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1514",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747021514",
            "telephone_number": "580-924-4704",
            "fax_number": "580-924-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 BRYAN DR",
            "address_2": "SUITE 100",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747017031",
            "telephone_number": "580-924-4704",
            "fax_number": "580-924-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAISWAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "JAISWAL",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-924-4704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1225296361",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1386698728",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200198250A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kendra Jackson, B.A, M.ED.
• Mary Anne Jackson
• Megan Jackson
• Ty Alan Jackson, PTA
• Miriam Kate Jacobs
• Deepak S. Jaiswal, M.D.
• Latoya Savon James, MHR, LADC-MH, LPC-S
• Janee Standifer SLP, LLC
• Michelle L Jennings, PA-C
• Olen Lynn Jestis II, D.O.

• Internal Medicine Physician in Durant, OK
• Providers in Durant, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.