Individual provider Active NPI

Tara Jaison, MD

  • Pediatrics Physician
  • Houston, TX
National Provider Identifier
1386223980
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
V2503 Issued in TX
Practice address
6411 Fannin St
Houston, TX 77030-1501
Phone
(713) 704-4000
Fax
(713) 704-5269
NPI assigned
Apr 2, 2021
Last updated
Jul 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Pediatrics Physician 208000000X V2503 TX Primary

Addresses

Primary practice location

6411 Fannin St
Houston, TX 77030-1501

Mailing address

6410 Fannin St Ste 318
Houston, TX 77030-3004

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
I20240806002215 TX Practitioner - Pediatric Medicine 1850838053 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians Pediatrics CurrentSince Sep 1, 2024 Accepting new patients
Ut Physicians CurrentSince Sep 1, 2024 Accepting new patients
Memorial Hermann Health System Past Accepting new patients

Locations

6410 Fannin St
#135
Houston, TX 77030

6410 Fannin St
Ste 318
Houston, TX 77030

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

6410 Fannin St
Ste 925
Houston, TX 77030

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

23900 Katy Fwy
Katy, TX 77494
Phone (281) 644-7000

8810 Highway 6
Ste 100
Sienna Plantation, TX 77459
Phone (713) 486-1200

17500 W Grand Pkwy S
Sugar Land, TX 77479
Phone (281) 725-5000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1386223980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST STE 318",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-704-4000",
            "fax_number": "713-704-5269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAISON",
        "first_name": "TARA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "V2503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.