Active NPI
Jason Phillip Jimenez, LSA
- Surgical Physician Assistant
- San Antonio, TX
National Provider Identifier
1407982523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- SA00556
- Practice address
- 540 Madison Oak Dr
Ste 610
San Antonio, TX 78258-3924 - Phone
- (210) 352-5346
- Fax
- (210) 352-5367
- NPI assigned
- Feb 25, 2007
- Last updated
- Dec 9, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | SA00556 | TX | Primary |
Addresses
Primary practice location
540 Madison Oak Dr
Ste 610
San Antonio, TX 78258-3924
Mailing address
10278 Mission CRK
Converse, TX 78109-1680
Phone (210) 685-7857
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SA00556 | Other | TX | LSA LICENSE |
| 85NN35 | Other | TX | BCBSTX |
| 12678940 | Other | TX | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA00556 | TX | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Antonio Surgical Assistants, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Surgical Assistant
- San Antonio, TX
- NPI 1518198688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670544000000",
"number": "1407982523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10278 MISSION CRK",
"city": "CONVERSE",
"state": "TX",
"postal_code": "781091680",
"telephone_number": "210-685-7857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 MADISON OAK DR",
"address_2": "STE 610",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782583924",
"telephone_number": "210-352-5346",
"fax_number": "210-352-5367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "JASON",
"middle_name": "PHILLIP",
"credential": "LSA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-25",
"last_updated": "2022-12-09",
"certification_date": "2022-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TX",
"license": "SA00556",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LSA LICENSE",
"identifier": "SA00556",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX",
"identifier": "85NN35",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "12678940",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.