NPIMap

Organization Active NPI

Physician Services of Jacksboro PA

  • Internal Medicine Physician
  • Jacksboro, TX
National Provider Identifier
1457657371
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
J8000 Issued in TX
Legal business name
PHYSICIAN SERVICES OF JACKSBORO PA
Practice address
709 N 4TH St
Jacksboro, TX 76458-1132
Phone
(817) 565-0922
NPI assigned
Feb 10, 2011
Last updated
Nov 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Authorized official

Name
Dr. Syed Jamal, M.D.NPI 1437157419
Title
Owner
Phone
(817) 565-0922

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X J8000 TX Primary

Addresses

Primary practice location

709 N 4TH St
Jacksboro, TX 76458-1132

Mailing address

PO Box 907
Frisco, TX 75034
Phone (817) 565-0922

Other identifiers 1

IdentifierTypeStateIssuer
0036XBOtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110509000807 TX Part B Supplier - Clinic/Group Practice 0345426383 Receives reassigned benefits from 10 practitioners
Practice locations: Jacksboro, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2253773Physician Services of Jacksboro, PA709 N 4TH St, Jacksboro, TX 76458Certificate of waiverFeb 23, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1297296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322006400000",
    "number": "1457657371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 907",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "817-565-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 N 4TH ST",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764581132",
            "telephone_number": "817-565-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES OF JACKSBORO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-10",
        "last_updated": "2011-11-23",
        "status": "A",
        "authorized_official_last_name": "JAMAL",
        "authorized_official_first_name": "SYED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-565-0922",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J8000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0036XB",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksboro, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.