Individual provider Active NPI

Jasmine S Pendergrass

  • Pediatrics Physician
  • Houston, TX
National Provider Identifier
1376002105
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
T6350 Issued in TX
Practice address
1504 Taub Loop
Houston, TX 77030-1608
Phone
(713) 798-1750
Fax
(713) 798-4693
NPI assigned
Mar 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X T6350 TX Primary

Addresses

Primary practice location

1504 Taub Loop
Houston, TX 77030-1608

Mailing address

1504 Taub Loop
Houston, TX 77030-1608
Phone (713) 798-1750

Other practice location 1

1 Baylor Plz # Bcm320
Houston, TX 77030-3411
Phone (832) 824-1170

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
I20220901002897 TX Practitioner - Pediatric Medicine 6800270331 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince May 21, 2022 Accepting new patients
Baylor College of Medicine CurrentSince May 21, 2022 Accepting new patients

Locations

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

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

Interoperability endpoints

  • Direct secure messaging: jpendergrass306161@prddirect.texaschildrens.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1376002105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 TAUB LOOP",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301608",
            "telephone_number": "713-798-1750",
            "fax_number": "713-798-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 TAUB LOOP",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301608",
            "telephone_number": "713-798-1750",
            "fax_number": "713-798-4693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz # Bcm320",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "832-824-1170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "JASMINE",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2022-09-26",
        "certification_date": "2022-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "T6350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.