NPIMap

Organization Active NPI

Stephanie Herrera, M.D and Associates, PA

Doing business as Lake Jackson Ear, Nose and Throat

  • Otolaryngology Physician
  • Lake Jackson, TX
National Provider Identifier
1841578754
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
STEPHANIE HERRERA, M.D AND ASSOCIATES, PA
Doing business as
Lake Jackson Ear, Nose and Throat
Practice address
215 Oak Dr S Ste F
Lake Jackson, TX 77566-5617
Phone
(979) 299-1520
Fax
(979) 299-1421
NPI assigned
Jul 26, 2011
Last updated
Jan 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Authorized official

Name
Dr. Stephanie Jo Herrera, M.D.NPI 1245534064
Title
Owner
Phone
(979) 299-1520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X TX Primary
Audiologist 231H00000X TX

Addresses

Primary practice location

215 Oak Dr S Ste F
Lake Jackson, TX 77566-5617

Mailing address

215 Oak Dr S Ste F
Lake Jackson, TX 77566-5617
Phone (979) 299-1520

Other identifiers 1

IdentifierTypeStateIssuer
284422701MedicaidTX

Other names 1

  • Lake Jackson Ear, Nose and Throat Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address SHerrera@lakejacksonent.emadirect.md Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110811000519 TX Part B Supplier - Clinic/Group Practice 3577732320 Receives reassigned benefits from 5 practitioners
Practice locations: Lake Jackson, TX

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: sherrera@lakejacksonent.emadirect.md

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1841578754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 OAK DR S STE F",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665617",
            "telephone_number": "979-299-1520",
            "fax_number": "979-299-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 OAK DR S STE F",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665617",
            "telephone_number": "979-299-1520",
            "fax_number": "979-299-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE HERRERA, M.D AND ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2023-01-18",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-299-1520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284422701",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SHerrera@lakejacksonent.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "215 Oak Dr S Ste F",
            "city": "Lake Jackson",
            "state": "TX",
            "country_code": "US",
            "postal_code": "775665617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lake Jackson Ear, Nose and Throat",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Jackson Ear, Nose and Throat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.