Ault McInnis PLLC
Organization Active NPI Family Medicine Physician · Jacksonville, TX
NPI 1942587159 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1942587159
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AULT MCINNIS PLLC
- Practice address
- 2114 E Rusk St
Jacksonville, TX 75766-9052 - Phone
- (903) 284-6105
- Fax
- (903) 284-6104
- NPI assigned
- Nov 16, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Kristin Lee Ault, DO
- Title
- Owner
- Phone
- (903) 284-6105
Owners & managing parties with NPI records 2
-
Kristin L Ault, DO
-
Justin M McInnis, MD
Practitioners 12
-
Kristin L Ault, DO
-
Ryan Earle, NP
-
Robert Michael Galbraith, D.O.
-
Justin M McInnis, MD
-
Jeffrey S Pilette, FNP
-
Craig C Weaver, MD
-
Maribel Arredondo, FNP
-
Holly Thompson, FNP-C
-
Shelbi Bolton, DO
-
Matthew Schimpf, PT, DPT
-
Karli Paige Parra, MSN, APRN, CPNP-PC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2090081 | Ault McInnis PLLC | Accreditation | Nov 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Rural health clinic certification: CCN 678936
- Legal name
- AULT MCINNIS PLLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 18, 2024
- Last certification
- Dec 18, 2024
- Ownership / control type
- 1C
- Organization structure
- Other · Proprietary
- Enrollment address
- 2114 E Rusk St
Jacksonville, TX 75766-9052
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Kristin L Ault |
5% Or Greater Direct Ownership Interest |
Nov 17, 2011 | 50% |
| Justin M McInnis |
Contracted Managing Employee | Nov 17, 2011 | |
| 5% Or Greater Indirect Ownership Interest |
Nov 17, 2011 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120124000385 | TX | Part B Supplier - Clinic/Group Practice | 9133396674 |
Receives reassigned benefits from 8 practitioners Practice locations: Jacksonville, TX |
| O20240117004725 | TX | Part a Provider - Rural Health Clinic | 9133396674 | Practice locations: Jacksonville, TX |
National Provider Directory
Locations
419 S Main St
Jacksonville, TX 75766
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
2114 E Rusk St
Jacksonville, TX 75766-9052
Mailing address
2116 E Rusk St
Jacksonville, TX 75766-9052
Phone (903) 284-6105
Other names
- FAMILY FIRST OF JACKSONVILLE
Other providers in Jacksonville, TX
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- Amanda Dawn Anderson
- John T Ardill
- Julian Avery Armstrong
- Assisted Living Concepts Inc
- Kristin L Ault
- Sharron Elaine Ballard
- Michael Dwaine Banks
- Be Well Mental Health Center PLLC
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All providers in Jacksonville, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.