Active NPI
Jefferson Roy Lowry, D.O.
- Otolaryngology Physician
- Fort Worth, TX
National Provider Identifier
1790758563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- F0567
- Practice address
- 1250 8TH Ave
Suite 135
Fort Worth, TX 76104 - Phone
- (817) 335-8151
- Fax
- (817) 335-2670
- NPI assigned
- Feb 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | F0567 | TX | |
| Otolaryngology Physician | 207Y00000X | F0567 | TX | Primary |
| Pediatric Otolaryngology Physician | 207YP0228X | F0567 | TX |
Addresses
Primary practice location
1250 8TH Ave
Suite 135
Fort Worth, TX 76104
Mailing address
1250 8TH Ave
Suite 135
Fort Worth, TX 76104
Phone (817) 335-8151
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 760330807 | Other | TX | TAX ID |
| PR29609650002 | Other | TX | CIGNA VENDOR NUMBER |
| 2940798 | Other | TX | AETNA PROVIDER # |
| 00000074EP | Other | TX | BLUE CROSS BLUE SHIELD ID |
| 0310740-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F0567 | TX | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patheous Medical PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397001600000",
"number": "1790758563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1250 8TH AVE",
"address_2": "SUITE 135",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76104",
"telephone_number": "817-335-8151",
"fax_number": "817-335-2670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 8TH AVE",
"address_2": "SUITE 135",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76104",
"telephone_number": "817-335-8151",
"fax_number": "817-335-2670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOWRY",
"first_name": "JEFFERSON",
"middle_name": "ROY",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-10",
"last_updated": "2014-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "TX",
"license": "F0567",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TX",
"license": "F0567",
"primary": true
},
{
"code": "207YP0228X",
"taxonomy_group": "",
"desc": "Otolaryngology, Pediatric Otolaryngology",
"state": "TX",
"license": "F0567",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "760330807",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA VENDOR NUMBER",
"identifier": "PR29609650002",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER #",
"identifier": "2940798",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD ID",
"identifier": "00000074EP",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0310740-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.