Jackson Surgical Consultants P.a.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

JACKSON SURGICAL CONSULTANTS P.A.

Doing business as

Revive Wellness

Practice address

1110 S Friendswood Dr
Friendswood, TX 77546-5698

Phone

(409) 299-4785

Fax

(409) 220-8348

NPI assigned

Jan 18, 2022

Organization subpart

No

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

Authorized official

Name

Marissa Deluna

Title

Credentialing Manager

Phone

(713) 800-3359

Specialties & licenses 2

Addresses

Other names 1

• Revive Wellness Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1326799610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12337 JONES RD STE 427",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770704951",
            "telephone_number": "409-299-4785",
            "fax_number": "409-220-8348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 S FRIENDSWOOD DR",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775465698",
            "telephone_number": "409-299-4785",
            "fax_number": "409-220-8348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON SURGICAL CONSULTANTS P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-18",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "DELUNA",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "713-800-3359"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Thuy Huynh, RPH
• Bret A Ibarra, D.D.S., M.S.D.
• Imo Sleep Solutions LLC
• Internal Medicine Clinic
• Annie Dunford Isaac, MHR, LBSW-IPR, LCDC
• Ashlynn Marie Jackson
• Jamine James
• Caroline Jarvis McKee, LPC-INTERN
• Jasmine Dental at Silverlake, PA (Jasmine Dental)
• JB Housing Group

• General Practice Physician in Friendswood, TX
• Providers in Friendswood, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.