LAKE JACKSON CLINIC, P.A.
NPI 1205830668
Family Medicine in Lake Jackson, TX
About Lake Jackson Clinic, P.a. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE JACKSON CLINIC, P.A. (NPI 1205830668) is a healthcare organization registered as a family medicine in Lake Jackson, Texas and active in the NPI registry since June 2005. The organization lists Liem P Bui, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lake Jackson Clinic, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lake Jackson Clinic, P.A., which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lake Jackson Clinic, P.A.'s NPI number?
The NPI number for Lake Jackson Clinic, P.A. is 1205830668. It was assigned to this organization in the NPPES registry on June 13, 2005.
Where is Lake Jackson Clinic, P.A. located?
Lake Jackson Clinic, P.A. is located at 101A Parking Way St, Lake Jackson, TX 77566. The listed phone number is (979) 297-2441.
What is Lake Jackson Clinic, P.A.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lake Jackson Clinic, P.A. enrolled in Medicare?
Yes. Lake Jackson Clinic, P.A. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lake Jackson Clinic, P.A.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Lake Jackson Clinic, P.A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Lake Jackson Clinic, P.A. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lake Jackson Clinic, P.a. · NPI 1205830668
Family Medicine organization in Lake Jackson, Texas. Organization record, active in the CMS NPPES registry since June 13, 2005.
## Identity
- **NPI:** 1205830668 (Entity type: Organization)
- **Enumerated:** June 13, 2005
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Liem Bui, PRESIDENT
## Practice location
- **Address:** 101A PARKING WAY ST, Lake Jackson, TX 77566-5228
- **Phone:** (979) 297-2441
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1205830668) · Data from the CMS NPPES public registry.