NPIMap

Individual provider Active NPI

Jennifer Dawn Kemmerer, P.A.-C

  • Physician Assistant
  • Conroe, TX
National Provider Identifier
1700880515
Registry record updated Oct 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04343 Issued in TX
Practice address
690 S Loop 336 West
Ste 222
Conroe, TX 77304-3320
Phone
(936) 756-6661
Fax
(936) 756-6681
NPI assigned
Jun 9, 2005
Last updated
Oct 21, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA04343 TX Primary
Surgical Physician Assistant 363AS0400X 1066468 TX

Addresses

Primary practice location

690 S Loop 336 West
Ste 222
Conroe, TX 77304-3320

Mailing address

690 S Loop 336 West
Ste 222
Conroe, TX 77304-3320
Phone (936) 756-6661

Other names 1

  • Jennifer Dawn Dibrell Former name

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
I20050228000831 TX Practitioner - Physician Assistant 1456304633 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
College Park Medicine,PAGroup PAC ID 7113964966, 11 clinicians

Practice addresses (Care Compare)

5834 Louetta Rd
Suite F
Spring, TX 77379-7884
Phone (936) 271-2555

690 S Loop 336
Conroe, TX 77304-3320
Phone (936) 523-7041

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Orthopaedic & Sports Medicine Past Accepting new patients
Ut Physicians Past Accepting new patients
Airrosti Rehab Centers, LLC Past Accepting new patients
Baylor College of Medicine Past Accepting new patients
Woodlands Pain Consultants,PA PastSince Aug 16, 2020 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 7

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 7

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413849600000",
    "number": "1700880515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 WEST",
            "address_2": "STE 222",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043320",
            "telephone_number": "936-756-6661",
            "fax_number": "936-756-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 WEST",
            "address_2": "STE 222",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043320",
            "telephone_number": "936-756-6661",
            "fax_number": "936-756-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMMERER",
        "first_name": "JENNIFER",
        "middle_name": "DAWN",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2014-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04343",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "1066468",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DIBRELL",
            "middle_name": "DAWN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.