NPIMap

Individual provider Active NPI

Jackson O Griggs, MD

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1861479818
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M1118 Issued in TX
Practice address
1600 Providence Dr
Waco, TX 76707-2261
Phone
(254) 313-4200
Fax
(254) 313-4531
NPI assigned
Dec 29, 2005
Last updated
Mar 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M1118 TX Primary

Addresses

Primary practice location

1600 Providence Dr
Waco, TX 76707-2261

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 1

IdentifierTypeStateIssuer
177687401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051110000592 TX Practitioner - Family Practice 9830117571 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M1118TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Texas Community Health Center, Inc Family Medicine CurrentSince May 4, 2018 Accepting new patients
Heart of Texas Community Health Center Inc Current Accepting new patients
Heart of Texas Community Health Center, Inc. Family Medicine CurrentSince May 4, 2018 Accepting new patients

Locations

1600 Providence Dr
Waco, TX 76707
Phone (254) 313-4200

Ownership & related parties

All facility ownership & control disclosures 15

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Waco Family Medicine - CentralWaco, TX, CCN 451917 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - West WacoWaco, TX, CCN 671874 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - BellmeadWaco, TX, CCN 671875 Federally qualified health center Corporate Director Feb 25, 2019
Waco Family Medicine - Women's HealthWaco, TX, CCN 671877 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - Elm AvenueWaco, TX, CCN 451919 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - Martin Luther King, Jr.Waco, TX, CCN 741873 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - Santa FeTemple, TX, CCN 741879 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - MacarthurWaco, TX, CCN 741880 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - Madison CooperWaco, TX, CCN 671013 Federally qualified health center Corporate Officer
Operational/Managerial Control (100%)		 Feb 25, 2019
Feb 25, 2019
Waco Family Medicine - ImperialWaco, TX, CCN 671149 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family Medicine - HillsboroHillsboro, TX, CCN 741113 Federally qualified health center Corporate Officer Feb 25, 2019
Waco Family MedicineTemple, TX, CCN 971095 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Feb 25, 2019
Feb 25, 2019
Waco Family MedicineWaco, TX, CCN 971100 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Feb 25, 2019
Feb 25, 2019
Waco Family MedicineWaco, TX, CCN 971110 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Feb 25, 2019
Feb 25, 2019
Waco Family MedicineWaco, TX, CCN 971106 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Feb 25, 2019
Feb 25, 2019

Owned or controlled facilities with NPI records 15

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 15

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1861479818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIGGS",
        "first_name": "JACKSON",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M1118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177687401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.