Individual provider Active NPI

Jack Guillory, PA-C

  • Physician Assistant
  • Houston, TX
National Provider Identifier
1396444766
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16589 Issued in TX
Practice address
7200 Cambridge St
Houston, TX 77030-4202
Phone
(713) 798-8106
NPI assigned
Feb 24, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X TX
Physician Assistant 363A00000X PA16589 TX Primary

Addresses

Primary practice location

7200 Cambridge St
Houston, TX 77030-4202

Mailing address

7200 Cambridge St Ste 10C
Houston, TX 77030-4202

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230803004637 TX Practitioner - Physician Assistant 5395106595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baylor College of MedicineGroup PAC ID 8022243971, 1,230 clinicians

Practice addresses (Care Compare)

2 Greenway PLZ
Suite 900
Houston, TX 77046-0205

7200 Cambridge St
Houston, TX 77030-4202

Hospital & facility affiliations

  • Baylor St Lukes Medical Center Hospital, Houston, TX, CCN 450193

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince Jun 1, 2023 Accepting new patients
Baylor College of Medicine CurrentSince Jun 1, 2023 Accepting new patients

Locations

7200 Cambridge St
Ste 10C
Houston, TX 77030
Phone (713) 798-0946

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

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

7200 Cambridge St
Fl 10
Houston, TX 77030
Phone 7137981750 ext. 2

7200 Cambridge St
Houston, TX 77030
Phone (713) 798-2400

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 1

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": "1677196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1396444766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 CAMBRIDGE ST STE 10C",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 CAMBRIDGE ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304202",
            "telephone_number": "713-798-8106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLORY",
        "first_name": "JACK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-24",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA16589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.