Jaden Heber Fackrell, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

U6714 Issued in TX

Practice address

3601 4TH St
Lubbock, TX 79430-0002

Phone

(806) 743-6144

NPI assigned

May 29, 2019

Last updated

Nov 6, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northstar Anesthesia, PA

  • Anesthesiology Physician
  • Arlington, TX
  • NPI 1912978610
  Medicare reassignment NPD
• NPH Anesthesia of Utah, LLC

  • Anesthesiology Physician
  • Ogden, UT
  • NPI 1366077273
  Medicare reassignment NPD

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1619534393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 4TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794300002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 4TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794300002",
            "telephone_number": "806-743-6144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKRELL",
        "first_name": "JADEN",
        "middle_name": "HEBER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-29",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "136115531205",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "U6714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyemart Express LLC
• Eyemart Express, LTD.
• Eyemasters of Texas LTD (EyeMasters)
• Jennifer Merle Ezell, FNP
• Emeka Arinze Ezeokeke
• Fadel Eye Group, LLC (Lubbock Eye Professionals)
• Tolulope Mary Fadipe, DDS
• Mandy M Fair, LMFT
• Jennifer-Marie C Fairchild, MA
• Kaeli Shea Faires, PHARMD

• Anesthesiology Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Anesthesiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.