Nibu Jacob Malaickal, REEGT, RPSGT,RNCST

Primary specialty

EEG Specialist/TechnologistTaxonomy code 246ZE0500X

License

4499

Practice address

304 S Coppell Rd
Coppell, TX 75019-2417

Phone

(214) 686-9393

NPI assigned

Nov 26, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Brainwave Neurodiagnostics LLC

  • Physiological Laboratory
  • McKinney, TX
  • NPI 1306486394
  NPD Authorized official

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

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1578033254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S COPPELL RD",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192417",
            "telephone_number": "214-686-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S COPPELL RD",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192417",
            "telephone_number": "214-686-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALAICKAL",
        "first_name": "NIBU",
        "middle_name": "JACOB",
        "credential": "REEGT, RPSGT,RNCST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "273100000X",
            "taxonomy_group": "",
            "desc": "Epilepsy Unit",
            "state": null,
            "license": "138",
            "primary": false
        },
        {
            "code": "246ZE0500X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, EEG",
            "state": null,
            "license": "4499",
            "primary": true
        },
        {
            "code": "246ZE0600X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": "878",
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": "16863",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luminous Medical Solutions LLC
• Jack Lusk
• Leigh Lynde, NP
• Magnolia Park Dental, PLLC (Magnolia Park Dental)
• Manuj Kumar Mahajan
• Jason Marc Marchetti, M.D.
• Jason Charles Mareno, D.C.
• Mark9Health PLLC (Mark9 Pediatrics)
• Martin Nunes DMD PLLC
• Benjamin John Martin, DMD, MS

• Other Specialist/Technologist in Coppell, TX
• Providers in Coppell, TX by specialty
• Other Specialist/Technologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.