NPIMap

Individual provider Active NPI

Jack A Maxwell, DO

  • Family Medicine Physician
  • Hickory Creek, TX
National Provider Identifier
1679585087
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G9368 Issued in TX
Practice address
3600 FM 2181 Ste 100
Hickory Creek, TX 75065-7636
Phone
(940) 497-2204
Fax
(940) 321-4977
NPI assigned
Aug 13, 2006
Last updated
Feb 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G9368 TX Primary
Sleep Medicine (Family Medicine) Physician 207QS1201X 2869 TX

Addresses

Primary practice location

3600 FM 2181 Ste 100
Hickory Creek, TX 75065-7636

Mailing address

3600 FM 2181 Ste 100
Hickory Creek, TX 75065-7636
Phone (940) 497-2204

Other identifiers 2

IdentifierTypeStateIssuer
124499802MedicaidTX
124499806MedicaidTX

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
I20080605000577 TX Practitioner - Family Practice 5698791671 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

3600 FM
2181 Suite 100
Hickory Creek, TX 75065-7636
Phone (940) 498-4422

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G9368TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group Family Medicine CurrentSince Jan 1, 2011 Accepting new patients
Texas Health Physicians Group CurrentSince Jan 1, 2011 Accepting new patients
Physicians and Allied Health Professionals Group, PA Family Medicine Past Accepting new patients
Highland Family Medical Centers PA Family Medicine PastSince Dec 10, 1955 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

3600 FM 2181
Ste 100
Hickory Creek, TX 75065
Phone (940) 497-2204

2012 Justin Rd
Ste 100
Lewisville, TX 75077
Phone (972) 317-1110

341 Wheatfield Dr
Ste 100
Sunnyvale, TX 75182
Phone (972) 329-1996

Interoperability endpoints

  • Direct secure messaging: jmaxwell88585@direct.texashealth.org

Organizations & group practices 5

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 6

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1679585087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 FM 2181 STE 100",
            "city": "HICKORY CREEK",
            "state": "TX",
            "postal_code": "750657636",
            "telephone_number": "940-497-2204",
            "fax_number": "940-321-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 FM 2181 STE 100",
            "city": "HICKORY CREEK",
            "state": "TX",
            "postal_code": "750657636",
            "telephone_number": "940-497-2204",
            "fax_number": "940-321-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "JACK",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G9368",
            "primary": true
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sleep Medicine",
            "state": "TX",
            "license": "2869",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124499802",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124499806",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory Creek, TX

Sources for this page

Verify at the official NPI Registry.