Jimmy W. Spruill, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

F2033 Issued in TX

Practice address

1275 Marvin Hancock Dr
Jasper, TX 75951-4935

Phone

(409) 384-1951

Fax

(409) 924-9696

NPI assigned

Jan 12, 2007

Last updated

Apr 28, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• East Texas Medical Center Healthcare Associates

  dba Texas Trauma and Emergency Care

  • Emergency Medicine Physician
  • Tyler, TX
  • NPI 1326082892
  NPD (past)
• East Texas Medical Center Trinity

  dba ETMC Trinity Pro Fees

  • Family Medicine Physician
  • Trinity, TX
  • NPI 1467787648
  NPD (past)
• East Texas Medical Center Trinity

  • General Acute Care Hospital
  • Trinity, TX
  • NPI 1821063553
  NPD (past)
• Jasper Emergency Medicine Associates PA

  • Emergency Medicine Physician
  • Jasper, TX
  • NPI 1346442746
  NPD (past)
• Southeast Emergency Physician Associates, P.a.

  • Emergency Medicine Physician
  • Beaumont, TX
  • NPI 1235155102
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398643200000",
    "number": "1255481883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3560 DELAWARE ST",
            "address_2": "SUITE 601-A",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777063067",
            "telephone_number": "800-258-2016",
            "fax_number": "409-924-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 MARVIN HANCOCK DR",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "759514935",
            "telephone_number": "409-384-1951",
            "fax_number": "409-924-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPRUILL",
        "first_name": "JIMMY",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2014-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "F2033",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F2033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1399511-25",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00264261",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8142853",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5645622",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8R0098",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanndara M Slaydon
• Solitude Emergency Physicians, PLLC
• Southeast Texas Dental Center
• James Berthold Spencer, M.D.
• Steven G. Spencer, DDS
• Vicky St John, APRN
• Stat Services of Jasper County a, LLP (Stat Care EMS)
• Stat Services of Jasper County a, LLP (Stat Care EMS)
• Sweet Neches Properties, LTD. (Rayburn Health Care & Rehabilitation)
• Brent Parker Tanksley, LCDC

• Family Medicine Physician in Jasper, TX
• Providers in Jasper, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; 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.