Active NPI
Jacob Willard Reddick, M.D.
- Family Medicine Physician
- Lubbock, TX
National Provider Identifier
1912317587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- Q6092
- Practice address
- 5807 63Rd Street
Suite 200
Lubbock, TX 79424 - Phone
- (806) 785-0600
- Fax
- (806) 785-0606
- NPI assigned
- May 5, 2014
- Last updated
- Dec 17, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | AT5828009-960 | TX | |
| Family Medicine Physician | 207Q00000X | Q6092 | TX | Primary |
Addresses
Primary practice location
5807 63Rd Street
Suite 200
Lubbock, TX 79424
Mailing address
5807 63Rd Street
Suite 200
Lubbock, TX 79424
Phone (806) 785-0600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q6092 | Other | TX | TEXAS MEDICAL BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 6, 2025 through Feb 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT5828009-960 | TX | MD | Family Medicine Physician |
Interoperability endpoints
- jacob.reddick@direct.myteamcare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734393600000",
"number": "1912317587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5807 63RD STREET",
"address_2": "SUITE 200",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79424",
"telephone_number": "806-785-0600",
"fax_number": "806-785-0606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5807 63RD STREET",
"address_2": "SUITE 200",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79424",
"telephone_number": "806-785-0600",
"fax_number": "806-785-0606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDICK",
"first_name": "JACOB",
"middle_name": "WILLARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-05",
"last_updated": "2024-12-17",
"certification_date": "2024-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "AT5828009-960",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "Q6092",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS MEDICAL BOARD",
"identifier": "Q6092",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.