Individual provider Active NPI

Jennifer Margarita Seale, MD

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1407295785
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q6696 Issued in TX
Practice address
1600 Providence Dr
Waco, TX 76707-2261
Phone
(254) 313-4200
Fax
(254) 313-4531
NPI assigned
Jun 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BP10047966 TX
Family Medicine Physician 207Q00000X Q6696 TX Primary

Addresses

Primary practice location

1600 Providence Dr
Waco, TX 76707-2261

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other names 1

  • Jennifer Margarita Roncallo Former name

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
I20160222002484 TX Practitioner - Family Practice 1254636707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas a & M University System, HSC, College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10047966TXMDFamily Medicine Physician
Q6696TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Texas Community Health Center, Inc. Family Medicine CurrentSince May 11, 2018 Accepting new patients
Heart of Texas Community Health Center Inc Current Accepting new patients
Heart of Texas Community Health Center, Inc Family Medicine CurrentSince May 11, 2018 Accepting new patients

Locations

600 S 25th St
Temple, TX 76504
Phone (254) 771-8200

1600 Providence Dr
Waco, TX 76707
Phone (254) 313-4200

1800 Gurley Ln
Waco, TX 76706
Phone (254) 313-6000

609 Elm Ave
Waco, TX 76704
Phone (254) 313-6900

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1407295785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEALE",
        "first_name": "JENNIFER",
        "middle_name": "MARGARITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-19",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10047966",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q6696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "RONCALLO",
            "middle_name": "MARGARITA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.