Surya Jacob, M.D

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

R8018 Issued in TX

Practice address

18440 W Airport Blvd Ste 350
Richmond, TX 77407-5100

Phone

(281) 240-8374

Fax

(281) 208-9504

NPI assigned

Apr 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjacob72744@direct.kelsey-seybold.com

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.

• Kelsey-Seybold Medical Group, PLLC

  dba Kelsey Seybold Clinic

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1013915255

  Pediatrics

  Medicare reassignment NPD
• Texas Family Pediatric Group, P.a.

  • Pediatrics Physician
  • Missouri City, TX
  • NPI 1275719437
  NPD (past)

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1699161273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 SHADOW CREEK PKWY",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775847298",
            "telephone_number": "713-442-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18440 W AIRPORT BLVD STE 350",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774075100",
            "telephone_number": "281-240-8374",
            "fax_number": "281-208-9504"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20303 S University Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Missouri City",
            "state": "TX",
            "postal_code": "774593662",
            "country_code": "US",
            "telephone_number": "281-208-9503",
            "fax_number": "281-208-9504",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2940 Eldridge Pkwy",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770826878",
            "country_code": "US",
            "telephone_number": "713-442-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "SURYA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-10",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R8018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "386566901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariana Jackson
• Candice Jackson
• Claude Nathaniel Jackson IV, SLP
• Deon Jackson
• Kristal Jackson, LPC
• Erin Jacobs, MA, LMFT
• Jade Community Care, Inc.
• Ruchi H Jadeja, O.D.
• Akinwunmi Jaiyesimi
• Prine Adeleke Jaiyesimi

• Pediatrics Physician in Richmond, TX
• Providers in Richmond, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.