Jacqueline Heredia Gracia, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

P7646 Issued in TX

Practice address

2192 Rosita Valley Rd
Eagle Pass, TX 78852-2503

Phone

(830) 421-5349

Fax

(830) 421-5417

NPI assigned

Apr 1, 2010

Sex

Female

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 2

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

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.

• Kickapoo Traditional Tribe of Texas

  • Health Service Clinic/Center
  • Eagle Pass, TX
  • NPI 1821159518
  Medicare reassignment NPD

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455580800000",
    "number": "1275858227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2192 ROSITA VALLEY RD",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788522503",
            "telephone_number": "830-421-5349",
            "fax_number": "830-421-5417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2192 ROSITA VALLEY RD",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788522503",
            "telephone_number": "830-421-5349",
            "fax_number": "830-421-5417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRACIA",
        "first_name": "JACQUELINE",
        "middle_name": "HEREDIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-01",
        "last_updated": "2016-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "P7646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF PEDIATRICS CERTIFICATION",
            "identifier": "691720",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX MEDICAL BOARD PHYSICIAN FULL PERMIT",
            "identifier": "P7646",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edgar A Gonzalez
• Elidia Gonzalez
• Fernanda Gonzalez, DMD
• Guadalupe Gonzalez
• Michelle Yvette Gonzalez, P.T.
• Melinda Dolores Grijalva, CPNP
• Guardian Angels Primary Home Care, Inc.
• Ana Luisa Guardiola, AFNP
• Yvette Ayla Guerra
• Guillermo Urueta Pediatrics PA

• Pediatrics Physician in Eagle Pass, TX
• Providers in Eagle Pass, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.