Individual provider Active NPI

Jackson Murrey-Ittmann, MD

  • Internal Medicine Physician
  • Houston, TX
National Provider Identifier
1326497017
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
S0950 Issued in TX
Practice address
6720 Bertner Ave
Houston, TX 77030-2604
Phone
(713) 798-2222
Fax
(713) 798-0111
NPI assigned
Jun 3, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301109557 MI
Internal Medicine Physician 207R00000X S0950 TX Primary
Hospitalist Physician 208M00000X S0950 TX

Addresses

Primary practice location

6720 Bertner Ave
Houston, TX 77030-2604

Mailing address

6620 Main St # 11B.285
Houston, TX 77030-2348
Phone (713) 798-2222

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190823002036 TX Practitioner - Internal MedicinePractitioner - Hospitalist 5193010684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baylor College of MedicineGroup PAC ID 8022243971, 1,230 clinicians

Practice addresses (Care Compare)

6720 Bertner Ave
Houston, TX 77030-2604
Phone (713) 798-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301109557MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince Sep 1, 2019 Accepting new patients
Baylor College of Medicine Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients

Locations

2 Greenway Plz
Ste 900
Houston, TX 77046
Phone (713) 798-1835

6620 Main St
#11B285
Houston, TX 77030

7200 Cambridge St
Fl 1
Houston, TX 77030
Phone (713) 798-3924

6720 Bertner Ave
Va Hospital, TX 77030
Phone (713) 785-8537

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1326497017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 MAIN ST # 11B.285",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302348",
            "telephone_number": "713-798-2222",
            "fax_number": "713-798-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 BERTNER AVE",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302604",
            "telephone_number": "713-798-2222",
            "fax_number": "713-798-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MURREY-ITTMANN",
        "first_name": "JACKSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-03",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301109557",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S0950",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "S0950",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.