Jack R Childress, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

H5535 Issued in TX

Practice address

105 Sequoya Dr
Lake Kiowa, TX 76240-9446

Phone

(940) 736-8885

Fax

(940) 668-8292

NPI assigned

May 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX, GA, LA3 enrollments

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 3

Specialty

Internal Medicine

Education

University of Texas Medical Branch at Galveston, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rural Physicians Group-Pannu PLLCGroup PAC ID 0345467486, 141 clinicians

Greater Texoma Health ClinicGroup PAC ID 3971650318, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside Medical Center Hospital, Franklinton, LA, CCN 191313
• Riverside Medical Center Nursing home, CCN 19Z313

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

Practice roles

Locations

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.

• Greater Texoma Health Clinic

  • Family Medicine Physician
  • Denison, TX
  • NPI 1386760023
  Medicare reassignment Care Compare group NPD
• Rural Physicians Group-Pannu PLLC

  • Hospitalist Physician
  • Greenwood Village, CO
  • NPI 1891236584

  GA, LA

  Medicare reassignment Care Compare group
• Cogent Healthcare of Texas, PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1992722953
  Medicare reassignment NPD
• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment NPD
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610
  Medicare reassignment NPD
• Hospitalist Medicine Physicians of Texas, PLLC

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1629307095
  Medicare reassignment NPD
• Center for Family Medicine,PA

  • Family Medicine Physician
  • Sherman, TX
  • NPI 1780808832
  NPD (past)
• Odessa Physician Associates, PLLC

  • Emergency Medicine Physician
  • Odessa, TX
  • NPI 1457398364
  NPD (past)
• Quantum Emergency Physicians PA

  dba DBA Quantum Hospitalist Physicians PA

  • Hospitalist Physician
  • Abilene, TX
  • NPI 1215010079

  Internal Medicine

  NPD (past)
• Texomacare

  • Family Medicine Physician
  • Denison, TX
  • NPI 1740233592

  Internal Medicine

  NPD (past)
• Theo Inpatient Services

  • Internal Medicine Physician
  • Eagle Pass, TX
  • NPI 1679719363
  NPD (past)
• Riverside Medical Center

  • Critical Access Hospital
  • Franklinton, LA
  • NPI 1700874062
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riverside Medical Center

  dba Riverside Pediatrics and Internal Medicine Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1093189797

  Hospital

  Care Compare affiliation
• Riverside Medical Center

  dba Riverside Surgical Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1104290949

  Hospital

  Care Compare affiliation
• Riverside Medical Center

  dba Riverside Cardiology Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1538634977

  Hospital

  Care Compare affiliation
• Riverside Medical Center

  • Critical Access Hospital
  • Franklinton, LA
  • NPI 1700874062
  Care Compare affiliation
• Riverside Medical Center

  dba Riverside Specialty Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1710438361

  Hospital

  Care Compare affiliation
• Riverside Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Franklinton, LA
  • NPI 1881756989

  Nursing home

  Care Compare affiliation
• Riverside Medical Center

  dba Riverside Internal Medicine Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1952751679

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1841245883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SEQUOYA DR",
            "city": "LAKE KIOWA",
            "state": "TX",
            "postal_code": "762409446",
            "telephone_number": "940-736-8885",
            "fax_number": "940-668-8292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SEQUOYA DR",
            "city": "LAKE KIOWA",
            "state": "TX",
            "postal_code": "762409446",
            "telephone_number": "940-736-8885",
            "fax_number": "940-668-8292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5995 Spring St",
            "address_purpose": "LOCATION",
            "city": "Warm Springs",
            "state": "GA",
            "postal_code": "318302149",
            "country_code": "US",
            "telephone_number": "706-655-3331",
            "fax_number": "866-368-6349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 S 15th St",
            "address_purpose": "LOCATION",
            "city": "Worland",
            "state": "WY",
            "postal_code": "824013531",
            "country_code": "US",
            "telephone_number": "307-347-3321",
            "fax_number": "866-368-6349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1900 Main St",
            "address_purpose": "LOCATION",
            "city": "Franklinton",
            "state": "LA",
            "postal_code": "704383688",
            "country_code": "US",
            "telephone_number": "985-839-4431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "JACK",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "346502",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "14502A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "97208",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "H5535",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H5535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-ARKANSAS",
            "identifier": "84487",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-TEXAS",
            "identifier": "8V4246",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1140766-07",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163713001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00466537",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vicki A Adsit, PT
• Skylar Dian Camacho, DC
• Crissy Cates
• Britten Trace Eddleman I
• Edward Lewis Emde, R.PH.
• Sarah Friedrich, DC
• Hh4U LLC (Home Helpers Home Care)
• Jami a. Hamilton, DC, LLC (Lake Kiowa Functional Chiropractic)

• Internal Medicine Physician in Lake Kiowa, TX
• Providers in Lake Kiowa, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.