Jack B Stephenson IV, M.D.

Primary specialty

Surgery of the Hand (Plastic Surgery) PhysicianTaxonomy code 2082S0105X

License

P5238 Issued in TX

Practice address

8591 S Broadway Ave
Tyler, TX 75703-5470

Phone

(903) 596-9173

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Plastic and Reconstructive SurgeryAlso: Hand Surgery

Education

Baylor College of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
• Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032
• Christus Mother Frances Hospital Sulphur Springs Hospital, Sulphur Springs, TX, CCN 450236

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jstephenson232786@christushealth.direct-ci.net
• Direct secure messaging: jack.stephenson.1@12039.direct.athenahealth.com

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

• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment Care Compare group NPD
• Acute Care Plastic Surgery PLLC

  • Plastic and Reconstructive Surgery Physician
  • Houston, TX
  • NPI 1427475631
  Medicare reassignment NPD
• Childrens Plastic Surgery PLLC

  • Plastic Surgery Physician
  • Houston, TX
  • NPI 1982977872
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Mother Frances Hospital Jacksonville

  dba CHRISTUS Mother Frances Hospital - Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672
  NPD
• Trinity Clinic

  dba Trinity Clinic Family Practice

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1922058304
  NPD (past)

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

• Christus Good Shepherd Medical Center

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1124092036
  Care Compare affiliation
• Christus Hopkins Health Alliance

  dba Christus Mother Frances - Sulphur Springs

  • General Acute Care Hospital
  • Sulphur Springs, TX
  • NPI 1033568621
  Care Compare affiliation
• Mother Frances Hospital Regional Health Care Center

  dba Christus Mother Frances Hospital Tyler

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Care Compare affiliation

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1972624542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8591 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035470",
            "telephone_number": "903-596-9173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8591 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035470",
            "telephone_number": "903-596-9173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1327 Troup Hwy",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757014443",
            "country_code": "US",
            "telephone_number": "903-606-8840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23960 Katy Freeway",
            "address_2": "Suite 380",
            "address_purpose": "LOCATION",
            "city": "Katy",
            "state": "TX",
            "postal_code": "77494",
            "country_code": "US",
            "telephone_number": "832-232-4263",
            "fax_number": "844-342-4263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHENSON",
        "first_name": "JACK",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "TX",
            "license": "P5238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael S. Stephens, D.C.
• Renee Stephens
• Tina Stephens
• Stephenson Pharmacy
• Stephenson Pharmacy, LLC
• Allison Sterken, LCSW
• Steve E Rowley DO PA (Long Term Care Associates)
• Steven G McCullough (Custom Care Orthopedic Bracing LLC)
• Steven G McCullough and David W Holt Orthotics & Prosthetics LLC (Custom Care Orthopedic Bracing and Prosthetics)
• Ashlyn Stevens, MCD, CF-SLP

• Surgery of the Hand (Plastic Surgery) Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Surgery of the Hand (Plastic Surgery) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.