Active NPI
Jeffrey Scott Berthot, P.A.
- Physician Assistant
- Nacogdoches, TX
National Provider Identifier
1932294550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA04204
- Practice address
- 4800 NE Stallings Dr
Suite 110
Nacogdoches, TX 75965-1249 - Phone
- (936) 569-9443
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA04204 | TX | Primary |
Addresses
Primary practice location
4800 NE Stallings Dr
Suite 110
Nacogdoches, TX 75965-1249
Mailing address
4800 NE Stallings Dr
Suite 110
Nacogdoches, TX 75965-1249
Phone (936) 569-9443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275436800000",
"number": "1932294550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 NE STALLINGS DR",
"address_2": "SUITE 110",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759651249",
"telephone_number": "936-569-9443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 NE STALLINGS DR",
"address_2": "SUITE 110",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759651249",
"telephone_number": "936-569-9443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTHOT",
"first_name": "JEFFREY",
"middle_name": "SCOTT",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2010-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA04204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
- Peter W. Baublet, C.R.N.A.
- Begins With You Case Management Incorporated
- James P Berg, M.D.
- Hallie Bernard
- Latrice Jeannette Berry, FNP
- Chelsea Durapau Bertrand, FNP-C
- Deidra Henderson Best, APRN, FNP-C
- Jennifer Raegan Best, MBA, RD, LD
- Bethany HH of Nacogdoches
- Bethany Home Health of East Texas, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.