Active NPI
Jack Bridges Bankhead, M.D.
- Internal Medicine Physician
- Plano, TX
National Provider Identifier
1619080728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- D6939
- Practice address
- 4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339 - Phone
- (972) 758-6000
- Fax
- (972) 758-6001
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D6939 | TX | Primary |
Addresses
Primary practice location
4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339
Mailing address
4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339
Phone (972) 758-6000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110160026 | Other | TX | RR MEDICARE |
| 1289126-06 | Medicaid | TX | |
| 128912604 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corsicana-Navarro County Public Health District | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- State or Local Public Health Clinic/Center
- Corsicana, TX
- NPI 1164467742
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214697600000",
"number": "1619080728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4708 ALLIANCE BLVD STE 300",
"address_2": "BAYLOR MEDICAL PLAZA 1",
"city": "PLANO",
"state": "TX",
"postal_code": "750935339",
"telephone_number": "972-758-6000",
"fax_number": "972-758-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4708 ALLIANCE BLVD STE 300",
"address_2": "BAYLOR MEDICAL PLAZA 1",
"city": "PLANO",
"state": "TX",
"postal_code": "750935339",
"telephone_number": "972-758-6000",
"fax_number": "972-758-6001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANKHEAD",
"first_name": "JACK",
"middle_name": "BRIDGES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2008-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TX",
"license": "D6939",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "110160026",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1289126-06",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "128912604",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.