Individual provider Active NPI

Blessy S Jacob, DNP

  • Primary Care Nurse Practitioner
  • Houston, TX
National Provider Identifier
1831499029
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP119563 Issued in TX
Practice address
11230 Airline Dr
Ste#1
Houston, TX 77037-1116
Phone
(832) 810-9521
Fax
(855) 703-1949
NPI assigned
Oct 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP119563 TX
Adult Health Nurse Practitioner 363LA2200X 685775 TX
Primary Care Nurse Practitioner 363LP2300X AP119563 TX Primary

Addresses

Primary practice location

11230 Airline Dr
Ste#1
Houston, TX 77037-1116

Mailing address

11230 Airline Dr
Ste#1
Houston, TX 77037-1116
Phone (832) 810-9521

Other practice location 1

2714 Cypress Point Dr
Ste # A
Missouri City, TX 77459-2600
Phone (713) 703-7684

Other identifiers 1

IdentifierTypeStateIssuer
3153637MedicaidTX

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
I20120921000346 TX Practitioner - Nurse Practitioner 7416105176 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

11230 Airline Dr
Suite 1
Houston, TX 77037-1116
Phone (832) 805-9520

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
685775TXMDAdult Health Nurse Practitioner
AP119563TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vipul M. Patel, MD.,PA CurrentSince Aug 3, 2012 Accepting new patients
Mount Carmel Medical Clinic PLLC CurrentSince Jun 26, 2020 Accepting new patients

Locations

11230 Airline Dr
Ste 1
Houston, TX 77037
Phone (832) 805-9520

11230 Airline Dr
Houston, TX 77037

2714 Cypress Point Dr
Ste A
Missouri City, TX 77459
Phone (832) 810-9520

629 Southmore Ave
Pasadena, TX 77502
Phone (713) 475-1933

Interoperability endpoints

  • Direct secure messaging: bjacob468716@direct.stlukeshealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1831499029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 AIRLINE DR",
            "address_2": "STE#1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770371116",
            "telephone_number": "832-810-9521",
            "fax_number": "855-703-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11230 AIRLINE DR",
            "address_2": "STE#1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770371116",
            "telephone_number": "832-810-9521",
            "fax_number": "855-703-1949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2714 Cypress Point Dr",
            "address_2": "Ste # A",
            "address_purpose": "LOCATION",
            "city": "Missouri City",
            "state": "TX",
            "postal_code": "774592600",
            "country_code": "US",
            "telephone_number": "713-703-7684",
            "fax_number": "855-703-1949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "BLESSY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-22",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP119563",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "685775",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP119563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3153637",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.