NPIMap

Organization Active NPI

Ault McInnis PLLC

Doing business as Family First of Jacksonville

  • Family Medicine Physician
  • Jacksonville, TX
National Provider Identifier
1942587159
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AULT MCINNIS PLLC
Doing business as
Family First of Jacksonville
Practice address
2114 E Rusk St
Jacksonville, TX 75766-9052
Phone
(903) 284-6105
Fax
(903) 284-6104
NPI assigned
Nov 16, 2011
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Dr. Kristin Lee Ault, DONPI 1609078211
Title
Owner
Phone
(903) 284-6105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
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 1

  • FAMILY FIRST OF JACKSONVILLE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942587159. Details of each certification follow.

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
OtherProprietary
Enrollment address
2114 E Rusk St
Jacksonville, TX 75766-9052

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2090081Ault McInnis PLLC2114 E Rusk Street, Jacksonville, TX 75766AccreditationNov 10, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristin L Ault Individual 5% Or Greater Direct Ownership InterestOwner Nov 17, 2011 50%
Justin M McInnis Individual Contracted Managing Employee Nov 17, 2011
5% Or Greater Indirect Ownership InterestPhysician Nov 17, 2011 50%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1942587159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757669052",
            "telephone_number": "903-284-6105",
            "fax_number": "903-284-6104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2114 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757669052",
            "telephone_number": "903-284-6105",
            "fax_number": "903-284-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AULT MCINNIS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-16",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "AULT",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-284-6105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY FIRST OF JACKSONVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, TX

Sources for this page

Verify at the official NPI Registry.