Individual provider Active NPI

Jeff L McCorcle, PA-C

  • Surgical Physician Assistant
  • Fort Sam Houston, TX
National Provider Identifier
1750353652
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA03043 Issued in TX
Practice address
3851 Roger Brooke Dr
Fort Sam Houston, TX 78234-4501
Phone
(210) 916-1762
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA03043 TX Primary

Addresses

Primary practice location

3851 Roger Brooke Dr
Fort Sam Houston, TX 78234-4501

Mailing address

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (210) 916-1762

Other practice location 1

1100 Wilford Hall Loop Bldg 4554
Jbsa Lackland, TX 78236-5638
Phone (210) 916-1762

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130726000677 TX Order and Referring Only - Physician Assistant 6406097872

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA03043TXMDSurgical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1750353652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344501",
            "telephone_number": "210-916-1762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Wilford Hall Loop Bldg 4554",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "782365638",
            "country_code": "US",
            "telephone_number": "210-916-1762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORCLE",
        "first_name": "JEFF",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA03043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Sam Houston, TX

Sources for this page

Verify at the official NPI Registry.