Holly Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10119 Issued in TX

Practice address

4421 Highway 6 S Ste 100
College Station, TX 77845-6176

Phone

(979) 731-5200

Fax

(979) 731-5210

NPI assigned

Nov 17, 2015

Last updated

Jan 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Holly Koonce Former name

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Accentcare Home Health of McKinney Home health agency, McKinney, TX, CCN 679236
• Baylor Scott and White Medical Center Lake Pointe Hospital, Rowlett, TX, CCN 450742
• Hunt Regional Medical Center Hospital, Greenville, TX, CCN 450352
• Baylor Scott & White Institute for Rehabilitation Inpatient rehabilitation facility, Dallas, TX, CCN 453036

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hjackson837591@direct.sw.org

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.

• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936
  Medicare reassignment Care Compare group
• Healthtexas Provider Network

  dba Symmetry Anesthesia

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Colleyville, TX
  • NPI 1235135906
  NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Plano, TX
  • NPI 1003811639
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bir JV LLP

  dba Baylor Institute for Rehabilitation

  • Rehabilitation Hospital
  • Dallas, TX
  • NPI 1538465901

  Inpatient rehabilitation facility

  Care Compare affiliation
• Hunt Memorial Hospital District

  dba Hunt Regional

  • General Acute Care Hospital
  • Greenville, TX
  • NPI 1598750721
  Care Compare affiliation
• Lake Pointe Operating Company, LLC

  dba Baylor Scott & White Medical Center Lake Pointe

  • General Acute Care Hospital
  • Rowlett, TX
  • NPI 1205018439
  Care Compare affiliation
• Texas Home Health Group of McKinney, LLC

  dba AccentCare Home Health of McKinney

  • Home Health Agency
  • McKinney, TX
  • NPI 1639609084
  Care Compare affiliation

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1467826248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 HILL BLVD UNIT 104",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481482",
            "telephone_number": "817-573-5760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4421 HIGHWAY 6 S STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778456176",
            "telephone_number": "979-731-5200",
            "fax_number": "979-731-5210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Hill Blvd Unit 104",
            "address_purpose": "LOCATION",
            "city": "Granbury",
            "state": "TX",
            "postal_code": "760481482",
            "country_code": "US",
            "telephone_number": "817-573-5760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HOLLY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-17",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hjackson544627@direct.sw.org",
            "affiliation": "N",
            "address_1": "6257 Fm 2642 Blvd Ste 100",
            "city": "Royse City",
            "state": "TX",
            "country_code": "US",
            "postal_code": "751893224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "KOONCE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in College Station, TX
• Providers in College Station, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.