Individual provider Active NPI

Jamie Ellen Kirby, M.D.

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1699813378
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
P3179 Issued in TX
Practice address
5414 S Broadway Ave
Tyler, TX 75703-1335
Phone
(903) 581-1601
NPI assigned
Feb 2, 2007
Last updated
Oct 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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 0433607 KS
Family Medicine Physician 207Q00000X P3179 TX Primary

Addresses

Primary practice location

5414 S Broadway Ave
Tyler, TX 75703-1335

Mailing address

PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000

Other practice location 1

719 W Coke Rd Ste 3
Winnsboro, TX 75494-3060
Phone (903) 342-3760

Other practice location 2

2101 W Loop 281
Longview, TX 75604-2506
Phone (903) 315-4180

Other identifiers 17

IdentifierTypeStateIssuer
302017403MedicaidTX
8EZ110OtherTXBCBS
75-1976930-005OtherTXTRICARE
750818167002OtherTXTRICARE
P01876970OtherTXMEDICARE RAIL ROAD
8DG764OtherTXBCBS
8EZ029OtherTXBCBS
00T71UOtherTXBCBS BLUE
297758YS6VOtherTXMEDICARE
75-2616977-028OtherTXTRICARE
75-2616977OtherTXRAIL ROAD
75-2616977-001OtherTXTRICARE
75-2616977-002OtherTXTRICARE
75-2616977-118OtherTXTRICARE
302017401MedicaidTX
302017402MedicaidTX
P01081606OtherTXRAIL ROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 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

Enrollment IDStateProvider typePAC IDDetails
I20120725000798 TX Practitioner - Family Practice 4688726920 Reassigns benefits to 4 organizations
I20230119002898 OK Practitioner - Family Practice 4688726920 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DCS Medical PA CurrentSince Jul 1, 2020 Accepting new patients
Williams Medical Group Practice, LLC CurrentSince Jan 1, 2023 Accepting new patients
DCS Medical PA CurrentSince Jul 1, 2020 Accepting new patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Jun 6, 2013 Accepting new patients
Williams Medical Group Practice, LLC Family Medicine CurrentSince Jan 1, 2023 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Jul 2, 2012 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jun 6, 2013 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Jun 19, 2017 Accepting new patients

Locations

1817 Arlington St
Ada, OK 74820
Phone (580) 279-0985

901 W Main St
Durant, OK 74701
Phone (580) 634-2931

220 S Van Buren St
Enid, OK 73703
Phone (580) 234-9355

777 NW 63rd St
Fl 2
Oklahoma City, OK 73116

1115 E Tyler St
Athens, TX 75751
Phone (903) 292-5015

3201 University Dr E
Ste 135
Bryan, TX 77802
Phone (979) 703-1832

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

2101 W Loop 281
Longview, TX 75604
Phone (903) 315-4180

5414 S Broadway Ave
Tyler, TX 75703
Phone (903) 581-1601

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

719 W Coke Rd
Ste 3
Winnsboro, TX 75494
Phone (903) 342-3376

Interoperability endpoints

  • Direct secure messaging: jamie.kirby@22735065448452.direct.elationemr.com
  • Direct secure messaging: jkirby17142@christushealth.direct-ci.net

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1699813378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841656",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752841656",
            "telephone_number": "903-531-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5414 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031335",
            "telephone_number": "903-581-1601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "719 W Coke Rd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Winnsboro",
            "state": "TX",
            "postal_code": "754943060",
            "country_code": "US",
            "telephone_number": "903-342-3760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2101 W Loop 281",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756042506",
            "country_code": "US",
            "telephone_number": "903-315-4180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRBY",
        "first_name": "JAMIE",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0433607",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P3179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302017403",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EZ110",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-1976930-005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "750818167002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P01876970",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DG764",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EZ029",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BLUE",
            "identifier": "00T71U",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "297758YS6V",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-028",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "75-2616977",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-118",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302017401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302017402",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P01081606",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.