Jacqueline Fontenot Butler, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

Q2519 Issued in TX

Practice address

2901 N Fourth St
Emergency Room
Longview, TX 75605

Phone

(903) 758-1818

NPI assigned

Apr 9, 2012

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 identifiers 1

Other names 1

• Jacqueline Renee Fontenot Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbutler355033@ahs.direct-ci.com

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.

• Acs Primary Care Physicians Southwest, PA

  • Emergency Medicine Physician
  • Gainesville, TX
  • NPI 1538101019
  Medicare reassignment NPD
• Acute Care Specialists

  • Emergency Medicine Physician
  • Longview, TX
  • NPI 1740655273
  Medicare reassignment NPD

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1568728103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N FOURTH ST",
            "address_2": "EMERGENCY ROOM",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-758-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N FOURTH ST",
            "address_2": "EMERGENCY ROOM",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-758-1818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 S Beckham Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757011908",
            "country_code": "US",
            "telephone_number": "903-597-0351",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2901 N Fourth St",
            "address_2": "Emergency Room",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "75605",
            "country_code": "US",
            "telephone_number": "903-758-1818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "JACQUELINE",
        "middle_name": "FONTENOT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-09",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "Q2519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2188453",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FONTENOT",
            "middle_name": "RENEE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles Courtney Burtis, MD
• Bertha Ann Burton, LCDC
• Lindsey Kathleen Burton, SLPA
• Tamara Lachelsa Bush
• William Edward Bussey, DDS
• Tonya Butler
• Danielle Bybee
• C-Trilogy Comprehensive Clinical Care, PLLC
• Staci Cabbiness, LPC
• Kai Cade

• Emergency Medicine Physician in Longview, TX
• Providers in Longview, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.