Individual provider Active NPI

John A Maxwell, M.D.

  • Diagnostic Radiology Physician
  • Lake Jackson, TX
National Provider Identifier
1902872369
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
J2189 Issued in TX
Practice address
100 Medical Drive
Lake Jackson, TX 77566-5674
Phone
(979) 285-1937
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X J2189 TX Primary

Addresses

Primary practice location

100 Medical Drive
Lake Jackson, TX 77566-5674

Mailing address

PO Box 1547
Sedalia, MO 65302-1547
Phone (660) 826-5960

Other identifiers 2

IdentifierTypeStateIssuer
P00675466OtherTXRR MEDICARE
116444404MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080313000385 TX Practitioner - Diagnostic Radiology 6507941689 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J2189TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Singleton Associates PA Diagnostic Radiology CurrentSince Mar 6, 2018 Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince Mar 6, 2018 Accepting new patients
Susan Nichols Hostetter M D P a Diagnostic Radiology Past Accepting new patients

Locations

1110 N Sarah Dewitt Dr
Gonzales, TX 78629
Phone (830) 672-3845

6720 Bertner Ave
#270
Houston, TX 77030
Phone (832) 355-4092

6720 Bertner Ave
#2270
Houston, TX 77030
Phone (832) 355-4092

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

8633 Broadway St
Ste 109
Pearland, TX 77584
Phone (281) 412-3916

6720 Bertner Ave
Va Hospital, TX 77030
Phone (713) 785-8537

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1902872369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547",
            "telephone_number": "660-826-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL DRIVE",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665674",
            "telephone_number": "979-285-1937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J2189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00675466",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116444404",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

Verify at the official NPI Registry.