Active NPI
Texas Em-I Medical Services PA
- Emergency Medicine Physician
- Jasper, TX
National Provider Identifier
1457774648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- TEXAS EM-I MEDICAL SERVICES PA
- Practice address
- 1275 Marvin Hancock Dr
Jasper, TX 75951-4935 - Phone
- (409) 384-5461
- NPI assigned
- Jan 24, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William Jernberg, MD
- Title
- President
- Phone
- (469) 401-2386
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | Primary | ||
| Physician Assistant | 363A00000X | |||
| Nurse Practitioner | 363L00000X |
Addresses
Primary practice location
1275 Marvin Hancock Dr
Jasper, TX 75951-4935
Mailing address
13737 Noel Rd
Ste 1600
Dallas, TX 75240-1331
Phone (469) 401-2386
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031201000296 | TX | Part B Supplier - Clinic/Group Practice | 6507760543 |
Receives reassigned benefits from 96 practitioners This NPI is an additional NPI on the enrollment Practice locations: League City, TX; Webster, TX; McKinney, TX; Galveston, TX; Angleton, TX |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390521600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1390521600000",
"number": "1457774648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13737 NOEL RD",
"address_2": "STE 1600",
"city": "DALLAS",
"state": "TX",
"postal_code": "752401331",
"telephone_number": "469-401-2386",
"fax_number": "214-712-2444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 MARVIN HANCOCK DR",
"city": "JASPER",
"state": "TX",
"postal_code": "759514935",
"telephone_number": "409-384-5461"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TEXAS EM-I MEDICAL SERVICES PA",
"organizational_subpart": "NO",
"enumeration_date": "2014-01-24",
"last_updated": "2014-01-24",
"status": "A",
"authorized_official_last_name": "JERNBERG",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "469-401-2386",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jasper, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.