NPIMap

Individual provider Active NPI

Kristin L Ault, DO

  • Family Medicine Physician
  • Jacksonville, TX
National Provider Identifier
1609078211
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
BP10021679 Issued in TX
Practice address
2116 E Rusk St
Jacksonville, TX 75766-9052
Phone
(903) 284-6105
Fax
(903) 284-6140
NPI assigned
Jun 5, 2007
Last updated
Mar 7, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BP10021679 TX Primary

Addresses

Primary practice location

2116 E Rusk St
Jacksonville, TX 75766-9052

Mailing address

2116 E Rusk St
Jacksonville, TX 75766-9052
Phone (903) 284-6105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080610000644 TX Practitioner - Family Practice 0244300721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ault McInnis PLLCGroup PAC ID 9133396674, 7 clinicians

Practice addresses (Care Compare)

2114 E Rusk St
Jacksonville, TX 75766-9052
Phone (903) 284-6105

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
BP10021679TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ault McInnis PLLC Family Medicine CurrentSince Oct 25, 2011 Accepting new patients

Locations

2114 E Rusk St
Jacksonville, TX 75766
Phone (903) 284-6105

2116 E Rusk St
Jacksonville, TX 75766
Phone (903) 284-6105

Interoperability endpoints

  • Direct secure messaging: kristinault@ffoj.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ault McInnis PLLCJacksonville, TX, CCN 678936 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) Nov 17, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Ault McInnis PLLC

    dba Family First of Jacksonville

    • Family Medicine Physician
    • Jacksonville, TX
    • NPI 1942587159

    5% Or Greater Direct Ownership Interest

    CMS ownership

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331078400000",
    "number": "1609078211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757669052",
            "telephone_number": "903-284-6105",
            "fax_number": "903-284-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757669052",
            "telephone_number": "903-284-6105",
            "fax_number": "903-284-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AULT",
        "first_name": "KRISTIN",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2012-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10021679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, TX

Sources for this page

Verify at the official NPI Registry.