J. Coffy Pieternelle, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

H5946 Issued in TX

Practice address

5060 Shadow LN
Beaumont, TX 77706-7632

Phone

(409) 899-1499

Fax

(409) 899-1354

NPI assigned

Sep 1, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2012 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Southeast Texas OB GYN Associates PA

  • Obstetrics & Gynecology Physician
  • Beaumont, TX
  • NPI 1245361369
  NPD

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1245224591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 SHADOW LN",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067632",
            "telephone_number": "409-656-1163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 SHADOW LN",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067632",
            "telephone_number": "409-899-1499",
            "fax_number": "409-899-1354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETERNELLE",
        "first_name": "J.",
        "middle_name": "COFFY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "H5946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127792303",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "160036972",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerry Lynn Philmon, R.PH.
• Phuc Nhat Le MD PA
• Phuc Nhat Le MD PA
• Physicians Cardiovascular Diagnostic Center, L.L.P.
• Jennifer Pierce, SLP
• Mark A Pigno, D.D.S.
• Brittany Nicole Pina, CPHT
• Linda Gayle Pinder, LAN
• Pinnacle EMS LLC
• Pinnacle Health Facilities of Texas XI LP

• Obstetrics & Gynecology Physician in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Obstetrics & Gynecology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.