NPIMap

Individual provider Active NPI

Jasmine Pettiford, M.D.

  • Internal Medicine Physician
  • Porter, TX
National Provider Identifier
1447602685
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
S2874 Issued in TX
Practice address
25553 US Highway 59
Porter, TX 77365-5500
Phone
(713) 442-2100
NPI assigned
Jul 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X S2874 TX Primary

Addresses

Primary practice location

25553 US Highway 59
Porter, TX 77365-5500

Mailing address

11511 Shadow Creek Pkwy
Pearland, TX 77584-7298
Phone (713) 442-0000

Other identifiers 2

IdentifierTypeStateIssuer
402630402MedicaidTX
402630401MedicaidTX

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
Direct Messaging Address jpettiford29862@direct.kelsey-seybold.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191003002314 TX Practitioner - Internal Medicine 6800127929 Reassigns benefits to 1 organization
I20240227001791 NC Practitioner - Internal Medicine 6800127929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Georgetown University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3000 Rogers Rd
Suite 200
Wake Forest, NC 27587-5745
Phone (919) 470-6505

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S2874TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Internal Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. CurrentSince Mar 11, 2024 Accepting new patients
Kelsey-Seybold Medical Group, PLLC Internal Medicine CurrentSince Sep 16, 2019 Accepting new patients
Duke University Affiliated Physicians, Inc. Internal Medicine CurrentSince Mar 11, 2024 Accepting new patients

Locations

7200 Creedmoor Rd
Ste 208
Raleigh, NC 27613
Phone (919) 327-1650

3000 Rogers Rd
Ste 200
Wake Forest, NC 27587
Phone (919) 385-3450

2727 W Holcombe Blvd
Houston, TX 77025
Phone (713) 790-9412

8233 N Sam Houston Pkwy E
Humble, TX 77396
Phone (713) 442-2000

7010 Highway 6
Missouri City, TX 77459
Phone (713) 442-4200

11511 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 442-4997

11511 Shadow Creek Pkwy
Fl 1
Pearland, TX 77584

25553 Highway 59
Porter, TX 77365
Phone (713) 442-2100

Interoperability endpoints

  • Direct secure messaging: jpettiford29862@direct.kelsey-seybold.com
  • Direct secure messaging: jpettiford565647@direct.medicine.duke.edu

Organizations & group practices 4

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 9

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": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1447602685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25553 US HIGHWAY 59",
            "city": "PORTER",
            "state": "TX",
            "postal_code": "773655500",
            "telephone_number": "713-442-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIFORD",
        "first_name": "JASMINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S2874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402630402",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402630401",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR endpoint URL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "25553 US Highway 59",
            "city": "Porter",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773655500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpettiford29862@direct.kelsey-seybold.com",
            "affiliation": "N",
            "endpointDescription": "digital contact information",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "25553 US Highway 59",
            "city": "Porter",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773655500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Porter, TX

Sources for this page

Verify at the official NPI Registry.