Jeneva L Sumrall, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01264 Issued in TX

Practice address

676 FM 517 Rd W
Dickinson, TX 77539-3904

Phone

(713) 482-4535

NPI assigned

Nov 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, CA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Open Door Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Crescent City, CA
  • NPI 1497840656
  Medicare reassignment
• Open Door Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Eureka, CA
  • NPI 1417474966
  NPD
• Open Door Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Eureka, CA
  • NPI 1831713452
  NPD
• Amy L. Offutt, M.D., P.a.

  • Family Medicine Physician
  • Marble Falls, TX
  • NPI 1205965969
  NPD (past)
• Llano Regional Hospital

  • Family Medicine Physician
  • Llano, TX
  • NPI 1457652745

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1477535052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 AVE G",
            "city": "MARBLE FALLS",
            "state": "TX",
            "postal_code": "786545866",
            "telephone_number": "830-693-8234",
            "fax_number": "830-693-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 FM 517 RD W",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775393904",
            "telephone_number": "713-482-4535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "638 Main Street",
            "address_purpose": "LOCATION",
            "city": "Ferndale",
            "state": "CA",
            "postal_code": "955361157",
            "country_code": "US",
            "telephone_number": "707-786-4028",
            "fax_number": "707-786-9029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUMRALL",
        "first_name": "JENEVA",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54327",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10013474",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Dickinson, TX
• Providers in Dickinson, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.