Individual provider Active NPI

Jaclyn Lauren Siegel, DO

  • Pediatric Gastroenterology Physician
  • Houston, TX
National Provider Identifier
1720584618
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
T3699 Issued in TX
Practice address
6410 Fannin St Ste 500
Houston, TX 77030-3005
Phone
(323) 256-5158
Fax
(713) 500-5750
NPI assigned
Apr 1, 2018
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X T3699 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X 58.030434 OH

Addresses

Primary practice location

6410 Fannin St Ste 500
Houston, TX 77030-3005

Mailing address

6431 Fannin St # 3.1347
Houston, TX 77030-1501

Other practice location 1

1515 Holcombe Blvd
Houston, TX 77030-4000
Phone (713) 792-6161

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240618000085 TX Practitioner - Pediatric Medicine 8921355264 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T3699TXMDPediatric Gastroenterology Physician
58.030434OHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians CurrentSince Jul 29, 2024 Accepting new patients
Ut Physicians CurrentSince Jul 29, 2024 Accepting new patients
Physicians Referral Service CurrentSince Sep 3, 2024 Accepting new patients

Locations

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

1515 Holcombe Blvd
#M
Houston, TX 77030
Phone (713) 792-2121

6410 Fannin St
#135
Houston, TX 77030

1515 Holcombe Blvd
#R4212
Houston, TX 77030
Phone (713) 794-5446

6410 Fannin St
Ste 824
Houston, TX 77030
Phone (713) 486-7853

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

1515 Holcombe Blvd
Houston, TX 77030
Phone (713) 794-5446

6431 Fannin St
#31347
Houston, TX 77030

Organizations & group practices 3

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": "1522540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1720584618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST # 3.1347",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST STE 500",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303005",
            "telephone_number": "323-256-5158",
            "fax_number": "713-500-5750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 Holcombe Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770304000",
            "country_code": "US",
            "telephone_number": "713-792-6161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIEGEL",
        "first_name": "JACLYN",
        "middle_name": "LAUREN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-01",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "TX",
            "license": "T3699",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "58.030434",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.