Lake Granbury Internal Medicine & Pediatrics, PA
NPI 1972608636ActiveOrganization· Internal Medicine· Granbury, TX
Internal Medicine in Granbury, Texas, registered in NPPES in September 2006. The authorized official on file is Penelope A. Jackson, M.D., Physician/Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1972608636 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 14, 2006 |
| Last updated in NPPES | Apr 2, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | — | — |
| Pediatrics | 208000000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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