NPIMap

Individual provider Active NPI

Joseph Dillon Jenkins, D.O.

  • Family Medicine Physician
  • Port Lavaca, TX
National Provider Identifier
1962655803
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q4145 Issued in TX
Practice address
1016 N Virginia St
Port Lavaca, TX 77979-3000
Phone
(361) 552-0325
Fax
(361) 500-6904
NPI assigned
Oct 23, 2008
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02003610A IN
Family Medicine Physician 207Q00000X Q4145 TX Primary

Addresses

Primary practice location

1016 N Virginia St
Port Lavaca, TX 77979-3000

Mailing address

1016 N Virginia St
Port Lavaca, TX 77979-3000
Phone (361) 552-0325

Other practice location 1

36000 Darnall Loop Carl R. Darnall Army Medical Center
Fort Hood, TX 76544
Phone (254) 288-8280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150701000617 TX Practitioner - Family Practice 4284946419 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Medical CenterGroup PAC ID 3072403096, 16 clinicians

Practice addresses (Care Compare)

1016 N Virginia St
Port Lavaca, TX 77979-3000

815 N Virginia St
Port Lavaca, TX 77979-3025
Phone (361) 552-6713

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003610AINMDFamily Medicine Physician
Q4145TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Medical Center CurrentSince Sep 15, 2018 Accepting new patients
Memorial Medical Center CurrentSince Sep 15, 2018 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
Memorial Medical Center Past Accepting new patients

Locations

1016 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-0325

815 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-0325

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1962655803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793000",
            "telephone_number": "361-552-0325",
            "fax_number": "361-500-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793000",
            "telephone_number": "361-552-0325",
            "fax_number": "361-500-6904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36000 Darnall Loop Carl R. Darnall Army Medical Center",
            "address_purpose": "LOCATION",
            "city": "Fort Hood",
            "state": "TX",
            "postal_code": "76544",
            "country_code": "US",
            "telephone_number": "254-288-8280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "JOSEPH",
        "middle_name": "DILLON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-23",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003610A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q4145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Lavaca, TX

Sources for this page

Verify at the official NPI Registry.