NPIMap

Individual provider Active NPI

Jack Ni

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1992198188
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R4609 Issued in TX
Practice address
Baylor Scott & White All Saints Medical Center
1400 8TH Ave
Fort Worth, TX 76104-4192
Phone
(817) 926-2544
NPI assigned
Mar 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R4609 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

Baylor Scott & White All Saints Medical Center
1400 8TH Ave
Fort Worth, TX 76104-4192

Mailing address

5870 Hiatus Rd
Pe Dept - West Region
Tamarac, FL 33321-6424
Phone (888) 447-2362

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jni457296@direct.sw.org

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
I20180920002408 TX Practitioner - Internal Medicine 8729379631 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

1400 8TH Ave
Fort Worth, TX 76104-4110

4001 Worth St
Dallas, TX 75246-1608

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

Hospital & facility affiliations

  • Healthy Choice Homecare LLC Hospice, Plano, TX, CCN A91761
  • Baylor Scott and White All Saints Medical Center Hospital, Fort Worth, TX, CCN 450137
  • Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135
  • Baylor Scott and White Emergency Hospital Hospital, Burleson, TX, CCN 670107

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R4609TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Sep 1, 2019 Accepting new patients
Lonestar Hospital Medicine Associates, PA Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Healthtexas Provider Network CurrentSince Sep 1, 2019 Accepting new patients
Healthtexas Provider Network Internal Medicine Current Accepting new patients
Baylor All Saints Medical Center Past Accepting new patients
Baylor Medical Center at Waxahachie Past Accepting new patients

Locations

5870 N Hiatus Rd
Tamarac, FL 33321
Phone (957) 377-2954

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

2700 E Broad St
Mansfield, TX 76063
Phone (682) 242-2000

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: jni457296@direct.sw.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Healthy Choice Homecare, LLCPlano, TX, CCN A91761 Hospice W-2 Managing Employee (20%) Dec 4, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

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": "1426032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1992198188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5870 HIATUS RD",
            "address_2": "PE DEPT - WEST REGION",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333216424",
            "telephone_number": "888-447-2362",
            "fax_number": "865-560-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER",
            "address_2": "1400 8TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044192",
            "telephone_number": "817-926-2544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NI",
        "first_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-11",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "R4609",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jni457296@direct.sw.org",
            "affiliation": "N",
            "address_1": "Baylor Scott & White All Saints Medical Center",
            "address_2": "1400 8th Ave",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761044192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.